On-Time Prevention Program for Long Term Care: Clinical Decision Support

Slide Presentation

On June 17, 2013, William Spector and Sandra Hudak made a presentation at the American Health Information Management Association (AHIMA) Long-Term and Post-Acute Care (LTPAC) Health IT (HIT) Summit. This is the text version of their slide presentation.

Slide 1

On-Time Prevention Program for Long Term Care: Clinical Decision Support

Text Description is below the image.
 

William Spector, Ph.D. AHRQ
Sandra Hudak, MS RN SLH Clinical Consulting

Presentation at AHIMA
June 17, 2013
Baltimore, MD

Slide 2

Using HIT for Prevention in Nursing Homes

Text Description is below the image.
 

  • Pressure ulcers, falls, and preventable hospitalizations happen too often in nursing homes (NHs) despite regulatory and market approaches to encourage prevention and treatment.
  • Challenges for managing clinical risk:
    • Residents' changing risk profiles not readily available.
    • Daily documentation is fragmented across disciplines.
    • Difficult to assemble & summarize information from multiple sources to profile resident's risk.
    • MDS is focused on chronic care not acute changes that increase risk if not managed.
    • Most staff not using patient data to track changes and intervene.

Slide 3

On-Time Program: Components

Text Description is below the image.
 

  • Clinical decision support (CDS) tools embedded into HIT, evidence based & usable by front-line staff.
  • Strategies to integrate CDS tools into front-line NH practice.
  • Guided facilitation to support adoption of tools & strategies.
  • Focus on identifying & managing high risk residents to:
    • Prevent Pressure Ulcers.
    • Monitor Pressure Ulcer Healing.
    • Prevent Falls.
    • Reduce Potentially Avoidable Hospitalizations & ED Visits.
  • Prerequisites: HIT Vendor, Leadership commitment and multidisciplinary teams, data-driven QI.

Slide 4

On-Time Program: Research Support for Design Strategy

Text Description is below the image.
 

  • Evidence-based risk identification from literature.
  • Clinical expert panel review of tools and risk criteria.
  • Front line staff workgroup for input to tool development & considerations for work flow redesign:
    • Input about NH clinical operations.
    • Clinical expertise.
    • Represent chains, for-profits, nonprofits, variety of vendors.
  • Pilot test with actual data risk rules & impact to work flow.

Slide 5

On-Time Program: CDS Strategy

Text Description is below the image.
 

  • Identify risk criteria.
  • Identify information needs of all disciplines.
  • Incorporate data elements into existing clinical documentation (e.g., nurse, dietary & CNA).
  • Create resident risk profile reports, profile changes in risk:
    • Incorporate multiple information sources to profile residents at risk (clinical assessments, MDS assessment, orders).
  • Design simple weekly reports for front line & promote the use of information to guide decision making:
    • Focus on weekly changes.
    • Provide trends.
    • Patient and unit level information.
    • Summarize data to support root cause analysis to analyze system causes.
  • Provide strategies for integrating tools into practice.
  • Implementation of tool-use led by facilitator.
  • After 6-10 months facilities are independent of facilitator.

Slide 6

On-Time Program: Facilitation Strategy

Text Description is below the image.
 

  • 9-12 month implementation period:
    • Biweekly phone calls with each QI team.
    • Incorporate risk reports with ongoing processes & structures.
    • Engage front-line staff in workflow redesign
      • Huddles, weekly committee meetings, morning reports.
    • Access CDS reports to trigger early risk ID and intervention.
    • Strengthen multi-disciplinary team collaboration, communication & care coordination.

Slide 7

On-Time Program: Technology Strategy

Text Description is below the image.
 

  • Leverage EMR use to support QI efforts:
    • Educate front-line staff on information use.
    • Show concrete link between EMR and QI efforts.
  • Provide functional specifications for any vendor.
  • Use existing vendor software features for documentation.
  • Develop collaborative relationships with EMR vendors in LTC.
  • Partner with NH associations, QIOs and Health Departments.
  • Make On-Time available for future efforts.

Slide 8

HIT Vendors & On-Time Modules

Text Description is below the image.
 

Vendor Pressure Ulcer Prevention Pressure Ulcer Healing Falls Prevention Avoidable Transfers
Answers on Demand X*     X*
American Data / ECS X X X* X
eHealth / SigmaCare X X*    
Healthcare Systems Connection X      
HealthMEDX / Vision X X*   X*
LINTECH EMR X X    
Optimus EMR X     X*
Point Click Care X      
Resource Systems / CareTracker X      

* planning to add/complete in 2013.

Slide 9

On-Time Program: Evaluation and Upgrades

Text Description is below the image.
 

  • NY PrU Evaluation:
    • PrU analysis of changes in incidence rates at resident level.
    • Interrupted time-series design with comparison group.
    • Shows 60% reduction when integrate 3-4 reports.
  • California falls evaluation:
    • Clustered randomized control study in California NH chain with matching (Results in 2014).
  • Pilot test design and feasibility for avoidable hospitalization module (Results are final specs and implementation strategies; Dec. 2013).
  • Enhance training program for On-Time facilitators:
    • Road map for each training session.
  • Expand tools to provide appropriate clinical referrals and follow-ups for each identified risk factor.

Slide 10

For More Information

Text Description is below the image.
 

Return to Pressure Ulcer Prevention

Page last reviewed November 2014
Page originally created August 2014
Internet Citation: On-Time Prevention Program for Long Term Care: Clinical Decision Support. Content last reviewed November 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/pruprev/spectorhudaktxt.html