3/19/ , American Heart Association 1

Target: Heart Failure

University of New Mexico School of Medicine

Division of Cardiology

Development of HF Performance Measures:

Process, Barriers, and Spinoffs

Objectives

•

Describe the individual components of our process for ascertainment,

clinical care, clinical follow-up (care transitions), data entry, and

monitoring of HF patients in the University of New Mexico Hospital

system.

•

Demonstrate how these independent “parts” function together –

collaboration and cooperation and communication.

•

Identify the early and late barriers and “spin-offs” with this process or

“What will get in your way!”

Target: Heart Failure

•

An AHA initiative launched in 2010 whose purpose is to improve quality, care

transitions, and outcomes for patients with heart failure with a targeted initiative and

leveraging the American Heart Association’s premier quality improvement suite of

resources including Get With The Guidelines-Heart Failure.

•

Provide healthcare professionals with content-rich resources and materials designed to

help them advance heart failure awareness, prevention, treatment and recovery.

•

Participants must demonstrate > 50% compliance

on the following measures:

• Medication optimization

• Early follow-up and care coordination

• Enhanced patient education

Target: Heart Failure

•

ACEI/ARB at discharge

•

Evidence-based beta-blocker at discharge

•

Aldosterone Antagonist at discharge

•

Follow-up visit within 7 days

•

Referral to disease management program

•

Patient education (at least 60 min)

GWTG Target: HF

University of New Mexico Hospital

Performance

The “Why” and “How” of our Performance in 2012

 Midas alerts

 Lighthouse initiations

 Daily Admit List

 Admits by Dr. Cox

 Compiled in MSExcel list

 Screened in Power Chart

 Power Chart message to Dr. Cox

 Dr. Cox receives Email from Dr. Dodendorf

 Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality)

 Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education

 Dedicated data entry

 Periodic reports to check data

 Reports to Quality Chief Resident

Goals:

Quality patient care (proactive)

Complete, accurate data for GWTG

Provider feedback (resident education)

Start

: disarray in 9/2011 due to personnel changes

 PharmD does monthly orientation on Cardio ward



 Comparison of UHC (after Coding & Billing) data with GWTG data

Transitions of Care

 Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs) , HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse

Chief Resident Quality

 Monthly orientation to Cardio ward

 Project: HF Medication Reconciliation at Discharge

 HF Pt List revised

 Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies

 Better alignment with Quality Outcomes reports to TJC, CMS

 Electronic data sent to Dr. Dodendorf

 Composite to Dr. Cox and Chief Resident Quality

Indepth study of readmits Pharmacy

Barriers into Spinoffs

BARRIERS INTO SPINOFFS

Barrier

First

Fix

Better

Fix

Barrier

First

Fix

Better

Fix

Goals:

Quality patient care (proactive)

Complete, accurate data for

GWTG

Provider feedback (resident

education)

Quality Patient Care

ASCERTAINMENT OF HF PATIENTS



Midas alerts



Lighthouse initiations



Daily Admit List



Admits by Dr. Cox

 Compiled in MSExcel list

 Screened in Power Chart

 Power Chart message to Dr. Cox

 Dr. Cox receives Email from Dr. Dodendorf

 Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality)

 Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education

 Dedicated data entry

 Periodic reports to check data

 Reports to Quality Chief Resident

 HF Pt List revised Pharmacy

BNP List

Real-time Activation = Clinical Alerts/Clinical Orders

Patient

Pharmacy

Cardiac Rehab

RN Education

HF Nurse Educator

Outpatient HF Clinic

Quality Outcomes

Reports to Quality Chief Resident

Chief Resident Quality



Monthly orientation on

Cardio ward



Project: HF Medication

Reconciliation at Discharge

Clinical chart reviews

Possible revisions to GWTG patient list

Possible coding discrepancies

 PharmD does monthly orientation on Cardio ward



 Electronic data sent to Dr. Dodendorf

 Composite to Dr. Cox, PharmD, & Chief Resident Quality

 Dr. Cox provides feedback to resident including passing the rotation

 Improved compliance with GWTG standards

 Improved compliance with TJC, CMS standards

 Midas alerts

 Lighthouse initiations

 Daily Admit List

 Admits by Dr. Cox

 Compiled in MSExcel list

 Screened in Power Chart

 Power Chart message to Dr. Cox

 Dr. Cox receives Email from Dr. Dodendorf

 Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality)

 Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education

 Dedicated data entry

 Periodic reports to check data

 Reports to Quality Chief Resident

Comparison of UHC (after Coding & Billing) data with GWTG data

 HF Pt List revised

 Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies

 Better alignment with Quality Outcomes reports to TJC, CMS

 Midas alerts

 Lighthouse initiations

 Daily Admit List

 Admits by Dr. Cox

 Compiled in MSExcel list

 Screened in Power Chart

 Power Chart message to Dr. Cox

 Dr. Cox receives Email from Dr. Dodendorf

 Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality)

 Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education

 Dedicated data entry

 Periodic reports to check data

 Reports to Quality Chief Resident

Transitions of Care

 Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs) , HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse

 HF Pt List revised

Indepth study of readmits

Transition in Care

•

The 7- day follow-up scheduled at discharge

•

The 30-day visit data are ensured by use of dictation template (created by NP at HF

Clinic) and the use of dedicated database (clinical outpatient database)

•

Medication reconciliation at each step

•

Role of out-patient pharmacy services at HF Clinic

•

Cardiac Rehabilitation

Repeat Look at Process

 Midas alerts

 Lighthouse initiations

 Daily Admit List

 Admits by Dr. Cox

 Compiled in MSExcel list

 Screened in Power Chart

 Power Chart message to Dr. Cox

 Dr. Cox receives Email from Dr. Dodendorf

 Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality)

 Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education

 Dedicated data entry

 Periodic reports to check data

 Reports to Quality Chief Resident

Goals:

Quality patient care (proactive)

Complete, accurate data for GWTG

Provider feedback (resident education)

Start

: disarray in 9/2011 due to personnel changes

 PharmD does monthly orientation on Cardio ward



 Comparison of UHC (after Coding & Billing) data with GWTG data

Transitions of Care

 Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs) , HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse

Chief Resident Quality

 Monthly orientation to Cardio ward

 Project: HF Medication Reconciliation at Discharge

 HF Pt List revised

 Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies

 Better alignment with Quality Outcomes reports to TJC, CMS

 Electronic data sent to Dr. Dodendorf

 Composite to Dr. Cox and Chief Resident Quality

Indepth study of readmits Pharmacy

This process is like “braiding” 3 railroad tracks

•

First “railroad track”: Clinical Processes

•

Second “railroad track”: Identification and Ascertainment of HF Patients

•

Third “railroad track”: Chart Abstraction and Data Entry (EMR and Outcomes software)

•

Build in redundancy and backups