Enhanced Home Health Program Neema Haria, MHSA Performance Improvement Facilitator Cedars-‐Sinai Health System Cedars-‐Sinai Health System One of the largest not-‐for-‐proﬁt medical centers in the western United States with 886 licensed beds •  More than 10,200 full-‐Dme employees, 2,100 physicians on medical staﬀ, 2,800 nurses and more than 2,800 volunteers •  One of the few hospitals naDonwide awarded the Magnet Excellence in Nursing designaDon three consecuDve Dmes by the American Nurses CredenDaling Center for quality care and commitment to nursing development •  Consistently named one of America’s Best Hospitals by U.S. News & World Report, with 12 specialDes naDonally ranked in 2013 •  Cedars-‐Sinai Medical Group repeatedly ranked one of California’s top performing physician organizaDons for highest overall quality by the Integrated Healthcare AssociaDon 2 Our Approach Solutions from outside of the hospital environment to: •  Optimize patient health and experience across the continuum •  Build high performance win/win partnerships with providers and patients/families Los Angeles market for SNFs & Home Health Agencies There are over 100 Home Health Agencies that operate within Cedars-‐ Sinai’s Primary Service Area. 4 Root Causes for Home Health Readmissions A chart review of 45 Home Health paDents revealed recurring factors that likely contributed to preventable readmission within 30 days. •  PaDents & families oZen turn away Home Health agencies aZer hospital discharge •  Inconsistency in frequency of home visits post-‐discharge •  45% of readmissions occurred on a Saturday or Sunday •  PaDent/Family not communicaDng Red Flags to Home Health agency •  MedicaDon Management/ReconciliaDon •  Physicians not responsive when Home Health Agencies have quesDons/concerns 5 Enhanced Home Health Protocol A minimum of 7 touch points to occur within the first two weeks of discharge Week 1 À Pre-Discharge Hospital Visit with Home Health Liaison •  À Med rec Safety check Assessment & education •  •  •  24 – 48 Hrs prior to discharge Home visit Week 2 Home visit •  •  Med compliance Vitals Well-being assessment Monday-Thursday Minimum of 1 home visit Day after discharge Tuck-in Phone call •  •  Address questions Schedule next home visit 2nd Friday patient is at home Tuck-in Phone call •  •  Identify red flags Schedule next home visit Home visit •  •  •  1st Friday patient is at home Home visit •  •  •  Med compliance Vitals Well-being assessment 2nd weekend that patient is at home Med compliance Vitals assessment Schedule next home visit 1st weekend patient is at home Additional Home Health visits as needed Where we started: Enhanced Home Health Pilot Four high volume Home Health agencies tested the ‘Enhanced Home Health’ bundle during a 6-week period in February & March 2012. A total of 396 patients were enrolled. BASELINE Home Health Agency % 30-day Readmissions Feb 2011- Jan 2012 TEST OF CHANGE % 30-day Readmissions Feb 15-Mar 31 2012 Agency 1 12.7% 10.3% 121 Agency 2 12.1% 7.8% 103 Agency 3 14.7% 11.8% 110 Agency 4 17.3% 6.4% 62 # enrolled in TOC Feb 15-Mar 31 2012 35% Reduction 7 Were all EHH touch-points completed ? (N=151) YES; all touchpoints completed (78) 12% 9% NO; PaDents declined some (41) 52% NO; PaDent declined all (13) 27% Unknown (19) Data From Home Health Agencies on Readmitted patients during the following months: November 2012, December 2012, January 2013, April 2013, May 2013, and June 2013 8 Days to Readmission (N=151) Days to Readmission 200 100% 180 90% 160 80% 140 70% 120 60% 100 50% 80 40% 60 30% 40 20% 20 10% 0 0% 7 14 # readmifed paDents 21 30 % of readmissions Data From Home Health Agencies on Readmitted patients during the following months: November 2012, December 2012, February 2013, May 2013, and June 2013. 9 Reframing the Relationship to Build a Partnership 10 Using Core Values of Baldrige Health Care Criteria to Build Partnerships Visionary Leadership OrganizaDonal and Personal Learning Focus on the Future Value Workforce Membership and Partners Managing for innovaDon Management by Fact Agility Societal Responsibility and Community Health Focus on Results and CreaDng Value System PerspecDve PaDent-‐Focused Excellence 11 Agency Selection Process 12 Win-Win Relationships: Identified Areas of Improvement Clinical Protocols Home Health Teach-‐Back Voice of the Customer (PaDents and Primary care Physician Panel) Customer Service Experience Data Sharing: access to EHR Performance Measurement Systems Face Sheet Accuracy Supplies and DME 13 Components of EHH 2.0 7 Touch Points On-site Liaison MD Interface Standardized Assessments 24/7 On-Call Clinical Support Branding & Building Awareness Data Collection & Documentation Next Steps Go-‐Live date: March 1, 2014 15 16 Questions Neema Haria. MHSA Performance Improvement Facilitator Cedars-Sinai Health System [email protected] 17