Qualidigm

The Home Health National Quality Initiative

Project Overview
What's New
Tools & Resources
FAQs
Our Partners
Project Team
Events

Project Goals:

Statewide Goals Include:
Reducing acute care hospitalizations.
Improving the management of dyspnea.
Increasing immunization screening for flu and pneumonia.
Changing organizational culture to support quality improvement.
Implementing telehealth technology.

Improving the 11 publicly reported measures posted on the Home Health Compare website will also be an ongoing focus of the collaborative work between Qualidigm and Connecticut's home health agencies.

Project Overview

Imagine a health care system where every person receives the right care every time, and where staff and providers have the tools and resources to deliver that care. Qualidigm and the Centers for Medicare & Medicaid Services (CMS) are dedicated to realizing this vision.

Qualidigm, Connecticut's Quality Improvement Organization (QIO), is working to assist home health agencies improve care that will allow their patients to remain home and avoid unnecessary hospitalizations. As your QIO, we are committed to helping home health agencies deliver care that is consistently safe, effective, efficient, timely, person-centered and equitable.

Qualidigm will be working with Connecticut home health agencies on the following key strategies identified by CMS as part of the national Home Health Quality Initiative:

Measure and Report Performance - Identify opportunities for improvement and track progress. Provide publicly reported quality data to consumers to promote informed choice.
Adopt Health Information Technology - Use telehealth (monitoring patients at a distance by using telephones, computers and other information technologies) to help maintain patient independence and increase agency efficiency.
Redesign Care Processes - Provide proven tools and processes for care management and patient self-management. Design fundamental processes to deliver person-centered care that is safe and efficient.
Transform Organizational Culture - Change organizational culture to support quality improvement. Empower leaders and staff to identify quality issues and make changes by encouraging open communication and teamwork.

Project Goals:

Statewide Goals Include:

Reducing acute care hospitalizations.
Improving the management of dyspnea.
Increasing immunization screening for flu and pneumonia.
Changing organizational culture to support quality improvement.
Implementing telehealth technology.

Improving the 11 publicly reported measures posted on the Home Health Compare website will also be an ongoing focus of the collaborative work between Qualidigm and Connecticut's home health agencies.

Participating Home Health Agency Goals - Qualidigm works intensively with a subset of Connecticut home health agencies to:

Prevent the deterioration in health status of home health patients, thereby reducing acute care hospitalizations.
Improve the individual agency-selected outcome.
Increase the number of influenza and pneumococcal immunizations given.
Promote organizational culture change in the home health agency environment.
Improve patient outcomes as measured by the CMS publicly reported quality measures.
Implement emerging telehealth technologies to help reduce acute care hospitalization and redesign care processes.

Qualidigm's Approach:

Our staff works with home health agencies to improve quality of care by:

Partnership Building

Working with home health agency personnel, federal and state agencies, and consumer advocates to create partnerships that expand our knowledge and resources to promote quality improvement.

Performance Feedback

Utilizing monthly Outcome and Assessment Information Set (OASIS) data reports to evaluate progress and monitor improvement.
Helping consumers to understand and use the information provided by the Home Health Compare website to assess the quality of home health agencies. Assisting home health agencies in improving quality of care related to these measures.

Quality Improvement Training and Support

Sharing effective quality improvement strategies, expertise and educational materials through face-to-face meetings, conference calls and electronic communication.
Providing individualized quality improvement support to participating home health agencies.
Providing technical assistance regarding performance improvement, including assessment of plans of action (POAs).

Marketing and Communications

Recognizing outstanding quality improvement efforts through the Qualidigm Quality Awards program.
Providing customizable press releases for local media use that highlight and describe the home health agency's quality efforts.

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What's New

Conference Calls

Influenza: Staff Vaccination - October 31, 2007 (Audio recording)
Falls Prevention - November 5, 2007 (Audio recording)
Patient Self-management - December 12, 2007 (Audio recording)
Disease Management - January 7, 2008 (Audio recording)
Transitional Care - February 12, 2008 (Audio recording)

WebEx Training

Download the WebEx Player to view a WebEx recorded session.

How OASIS Accuracy Impacts Quality - April 12, 2007

Best Practices for Improvement in Management of Oral Medications - April 26, 2007

Best Practices for Acute Care Hospitalization - May 3, 2007

Best Practices for Improvement in Dyspnea - May 10, 2007

Best Practices for Emergent Care - May 24, 2007

Best Practices for Improvement in Ambulation/Locomotion - May 31, 2007

Best Practices for Improvement in Urinary Incontinence - June 14, 2007

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Tools & Resources

Wallet Medication Card

Qualidigm and the Qualidigm PSO are working with partners including the Connecticut Department of Public Health, CHA and the CHREF Patient Safety Organization to promote awareness of patient safety strategies and empower patients to be more active partners in their care. As the first step in this statewide effort to engage patients in safety, we have developed a wallet medication card in order to assist consumers in maintaining an accurate record of the medicines they take and other important information. It is critical that your health care providers have complete information about your medical history and current medications, and we encourage all consumers to use the wallet medication card or a similar tool to track this information. The wallet medication card and instructions are available in two formats by clicking on the links below. The first format (PDF) is for consumers who will print the card and complete it by hand. The second format (Word) is for consumers who would like to download the card as a Microsoft Word document and save it to their own computer for filling out electronically before printing.

Click here for Wallet Medication Card (PDF version).
Click here for Wallet Medication Card (Word version).

SBAR Tool - This Situational Briefing Model tool, developed by the Institute of Healthcare Improvement, can be used to improve nurse and physician communication when there is a change in the patient's condition.

S - Describe the Situation. In a few seconds, get someone's attention.
B - Background. Provide enough information to give the listener some context for the problem.
A - Assessment. Give your assessment of the overall condition.
R - Recommendation. Give your specific recommendations.

Tip Sheets

Front-Loading Visits
Medication Management
Patient Emergency Plan
Risk Assessment

MedQIC is a website where health care professionals can find and share quality improvement resources and browse through recommended interventions developed by colleagues and experts in their field. MedQIC offers tools, articles and links to resources about how to transform organizational culture, adopt health information technology, redesign care processes, and measure and report performance. The following are some examples:

Ambulation Locomotion
Any Emergent Care
Bathing
Discharge to Community
Dyspnea
Immunization
Oral Medications
Pain Interfering with Activity
Status of Surgical Wounds
Telehealth
Transferring
Urinary Incontinence

Tools for all the publicly reported outcomes are available on the Medicare Quality Improvement Community's website, MedQIC. Some suggested tools include:

Ready Aim Improve Reducing Acute Care Hospitalizations
Reducing Acute Care Hospitalizations audio for clinicians and one for home health aides.
Red - Yellow - Green Zone Self Management Tools for Asthma. Diabetes and Congestive Heart Failure in English and Spanish.

CMS Home Health Sites:
CMS' Home Health Quality Initiative
Home Health Prospective Payment System
Home Health Compare
Home Health Information Resource for Medicare
Beneficiary Notices Initiative

OASIS (Outcome and Assessment Information Set):
CMS' OASIS Home Page
CMS' OASIS Frequently Asked Questions
OASIS Web-based Training
OASIS Certificate and Competency Board

OBQI (Outcome Based Quality Improvement):
OBQI Implementation Manual
OBQI Web-based Training

Medicare and Home Health Care PDF (322 KB)
This booklet explains:

The home health benefit and who is eligible.
What is covered by the original Medicare plan.
How to find a home health agency.
Where you can get more help.

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FAQs

We have a new quality improvement coordinator. How does she get on the list to receive HHQI campaign information?
Complete the Home Health Agency Change of Information form found on the For Home Health Agencies page at www.homehealthquality.org.

I am resigning and want to make sure my replacement becomes the contact person for the campaign. What do I need to do?
Complete the Home Health Agency Change of Information form found on the For Home Health Agencies page at www.homehealthquality.org.

The address listed for our agency as a campaign participant is incorrect. Can you change that for me?
That address can only be modified through your state OSCAR/ASPEN coordinator. For more information about the procedure, go to the “For Home Health Agencies” page at www.homehealthquality.org and click on “View the instructions for address only change”.

Our agency has moved and we would like the new address reflected on the HHQI Campaign Web site. How do we get that changed?
That address can only be modified through your state OSCAR/ASPEN coordinator. For more information about the procedure, go to the “For Home Health Agencies” page at www.homehealthquality.org and click on “View the instructions for address only change”.

How can I more easily obtain the physician signature on my patient's plan of care (POC)?
Obtaining a physician signature on the POC is a difficult task for home health agencies. Many times the primary physician has not seen the patient prior to discharge and often does not receive a copy of the hospital discharge order in time to respond to agency requests.

When the patient returns home, the home care agency begins the POC and will contact the physician regarding any discrepancies found and to obtain orders. At that time, the physician will often refuse to discuss and/or sign the patient's orders until they see the patient, which causes problems for both the patient and the home care agency.

A temporary bandaid for this problem is sharing the discharge orders with the patient's primary physician when the patient is accepted by a home health agency.

Some hospitals have computer records that are available online for the primary physician to access. The goal is to set up and implement a system that will provide increased physician knowledge. With open communication, improved and coordinated patient care can be achieved.

What is the value of the report Acute Care Hospitalization: Actual Rates vs. Risk-Adjusted Rates?
The ACH Actual Rate (from OBQI Reports) vs. Risk Adjusted Rate (as Reported on Home Health Compare):

Visually demonstrates the difference between these two rates
Validates the importance of OASIS competency to accurately capture the health/functional status of your patient population that in turn
determines the risk adjustment factor
Encourages investigation when risk-adjusted rates vary significantly from actual rates
- Has your case mix changed?
- Are there staff "assumptions" that lead to erroneous assessment and documentation of a patient's status? One agency discovered that its nurses with an ICU background assessed all home care patients as not being very ill (compared to their status in the ICU)!

How are HHQI Participants using this information?

HHQI participants report they have more clearly identified the patients most at risk for rehospitalization as clinicians fine-tune their assessment skills
Others have decreased the disparity between actual and risk-adjusted rates through re-focused education based on the report

Isn’t risk adjustment supposed to help me?
The risk-adjusted rate is your agency’s ACH rate plus a risk-adjustment factor. The risk-adjustment factor takes into account differences between your agency’s patient population and the national patient population. If the risk-adjusted rate is HIGHER (worse) than the actual rate it means that your agency's patients are expected to be hospitalized less frequently than the average national patient.

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Our Partners

Centers for Medicare & Medicaid Services
Connecticut Association for Home Care
Visiting Nurse Associations of New England
Visiting Nurse Associations of America

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Project Team:

Quality Improvement Consultant
Kathy Roby, BSN, MA, MS, CHCE
860.632.3724
kroby@ctqio.sdps.org

Administrative Assistant
Doreen Ostapchuk
860.613.3699
dostapchuk@ctqio.sdps.org

Analysis
Shih-Yieh Ho, MPH, PhD

Marketing and Communications
Maxine Goldsmith, RN, MSN, MBA

Management
Anne Elwell, RN, BS, MPH, CPHQ

Research and Evaluation
Judith Barr, ScD

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Events

View all Home Health Events

Professionals

The Home Health National Quality Initiative

Project Goals:

Project Overview

Project Goals:

Qualidigm's Approach:

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What's New

Conference Calls

WebEx Training

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Tools & Resources

Wallet Medication Card

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FAQs

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Our Partners

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Project Team:

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Events