ReACH National Demonstration Collaborative: Reducing Acute Care Hospital Hospitalization

Slide presentation from the AHRQ 2008 conference showcasing Agency research and projects.

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Penny H. Feldman, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.7 MB; Plugin Software Help).

Slide 1

ReACH National Demonstration Collaborative: Reducing Acute Care Hospitalization

Overview

Penny H. Feldman, PhD
ReACH Principal Investigator
Visiting Nurse Service of New York (VNSNY)
Center for Home Care Policy and Research

The project team gratefully acknowledges the support from the Agency for Healthcare Research and Quality (AHRQ) (1 U18 HS 13694) and the Robert Wood Johnson Foundation (RWJ) (042588).

Slide 2

ReACH Structure and Objectives

  • Partnership to advance home health care quality.
    • VNSNY Center for Home Care Policy and Research (CHCPR).
    • Home care QIOSC—Quality Insights of PA.
    • 16 Quality Improvement Organizations (QIOs).
    • 169 home health agencies (HHAs) from 20 states.
  • Objectives:
    • Test a collaborative model for HHA practice improvement.
    • Reduce acute care hospitalization rates.

Slide 3

ReACH Partnership Model

Graphic shows three slightly overlapping circles in the center: ReACH Project Staff, QIOSC, and CHCPR, and nine clusters of seven smaller circles containing six HHA circles surrounding a somewhat larger QIO circle.

Slide 4

Background

  • 2002: Partnership for Achieving Quality Homecare (PAQH)—Funded by AHRQ and RWJ.
  • 2004: PAQH Diabetes Learning Collaborative:
    • 8 HHAs.
    • Significant improvement in 8 of 9 measures—30 percentage point increase in rate of patients with glucose in target range.
  • 2005: Acute Care Hospitalization (ACH) Pilot Project—QIOSC and CHCPR—evidence review and best practices.
  • 2005-2007: ReACH—2 seven-month waves.

Slide 5

Context

  • ˜8100 Medicare-certified HHAs; ˜3.4m discharges.
  • Mandated "OASIS" [Outcome and Assessment Information Set] assessments & publicly reported outcomes.
  • Impending pay for performance.
  • <20 percent agencies accredited.
  • Variable quality/weak quality infrastructure.
  • Dispersed work force/poor support for frontline managers.
  • No history of voluntary industry partnerships.
  • Centers for Medicare and Medicaid Services (CMS)-funded Home Health Quality Improvement Campaign (HHQI) 2007-2008.

Slide 6

ReACH Project Goal

  • Reduce acute care hospitalizations of home health patients and make substantial progress toward CMS target of 23 percent risk-adjusted rate (already achieved by 25% of all HHAs nationwide).
  • For those agencies with rates at 23% or lower: sustain the rate, and identify ways to reduce it further.

Slide 7

ReACH Best Practices

  • "Target" group selection (e.g.,region, office, dx).
  • Risk Assessment.
  • Emergency Plans and Risk-Appropriate Care Plans.
    • Front load visits and increase contacts (phone calls; telemedicine) for high risk patients.
  • Medication reconciliation.
  • Improved MD communication (Situation-Background-Assessment-Recommendation [SBAR]).

Slide 8

ReACH Evaluation

  • Level 1—Perceptions:
    • Participant satisfaction, challenges, lessons learned.
  • Level 2—Care processes:
    • Core measures, strategies and actions.
  • Level 3—Results:
    • Percentage of episodes ending with hospitalization.
  • Data sources:
    • Online surveys; phone interviews.
    • Monthly record reviews—data entered on line.
    • OASIS reports (Home Healthcare Compare.

Slide 9

ReACH Process Results

  • Two Bar graphs compare Times 1 and 2, showing Waves 1 and 2.
  • Scale on left reads 0 to 90.
  • Target patients with completed risk assessments:
    • Wave 1: Time 1=35 and Time 2=81 (+46.0).
    • Wave 2: Time 1=47.1 and Time 2=87.7 (+40.6).
  • Total patients in target group identified at risk:
    • Wave 1: Time 1=27 and Time 2=44 (+17.0).
    • Wave 2: Time 1=56.6 and Time 2=48.3 (-8.3).

Slide 10

ReACH Process Results: Target patients with risk-specific care plans

Bar graph compares Times 1 and 2 showing Waves 1and 2.

  • Wave 1: Time 1=22 and Time 2=72 (+50.0).
  • Wave 2: Time 1=18.4 and Time 2=62.8 (+44.4).

Slide 11

ReACH Process Results: Average home care visits in first two weeks for patients at-risk of hospitalization in target group:

Bar graph compares Times 1 and 2 showing Waves 1and 2.

  • Wave 1: Time 1=6.6 and Time 2=8.1 (+1.5).
  • Wave 2: Time 1=6.8 and Time 2=8.7 (+1.9).

Slide 12

ReACH Hospitalization Results: Home care episodes resulting in acute care hospitalization for target group

Bar graph compares Times 1 and 2 showing Waves 1and 2.

  • Wave 1: Time 1=31.7 and Time 2=27.7 (-4.0).
  • Wave 2: Time 1=36.2 and Time 2=28.8 (-7.4).

Slide 13

HHQI-National ACH Campaign results

  • Comparison of 7,452 Medicare-certified HHAs.
    • 4,352 Early Participating (EP) Agencies.
    • 972 Later Participating (LP) Agencies.
    • 2,128 Non Participating (NP) Agencies.
  • ACH rate over a 12-month period:
  •                   March 2007    February 2008.
  • EP              30.73%           30.48%
  • LP              32.06%           32.33%
  • NP             34.61%           35.39%
  • HHAs achieving at least 5% improvement:
  • EP (38.4%)    LP (37.9%)    NP (34.6%)

Slide 14

Challenges to ReACH Implementation

  • QIOs:
    • Varied expertise and skills.
    • Varied agency selection processes.
  • HHAs:
    • Varied QI experiences and skills.
    • Competing priorities.
    • Staff changes.
  • ReACH mechanism:
    • Long-distance faculty.
    • Reliance on QIOs to transmit skills/knowledge.
    • Technical issues related to virtual communication.
  • Evaluation:
    • Varied target groups.
    • Varied implementation of varied strategies and tools.

Slide 15

Lessons Learned

  • QIOs' need/demand for TA, tools, support.
  • HHAs' positive response to Collaborative Learning model.
    • Importance of face-to-face information transfer (local learning sessions) and TA.
  • Efficiencies from leveraging QIO resources.
    • Recruitment, TA, Data.
  • Value of:
    • Peer to peer reinforcement, shared experiences.
    • Web-based data collection.
    • Central resources.
  • Leadership involvement key.

Slide 16

Collaboration—Next Steps

  • Geriatric Cardiac Hospitalization Atherosclerosis Management Program (CHAMP) Program:
    • Promote National Framework to Advance Geriatric Home Care Excellence.
    • Build geriatric capacity in significant number of HHAs.
    • Achieve significant, measurable improvement in home care for older persons through:
      • E-learning programs.
      • A National Community of Practice to support quality improvement and share the Framework findings.
      • Corollary activities and products.
      • Collaborations (e.g., National Association for Home Care and Hospice [NAHC], Visiting Nurse Associations of America [VNAA], State associations; QIOSCs; accrediting bodies; consumer groups).
    • Funding—Atlantic Philanthropies, John A. Hartford Foundation, California Health Care Foundation, New York State Health Foundation, others.
Current as of February 2009
Internet Citation: ReACH National Demonstration Collaborative: Reducing Acute Care Hospital Hospitalization. February 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2008/Feldman.html