Post on 05-Jul-2020
10/23/2014
1
Pumping HHQI’sPumping HHQI s Cardiovascular Health Into ActionCindy Sun, MSN, RN, COS‐CCrystal Welch, MSN, RNMisty Kevech, MSN, RN, COS‐C
Objectives
Describe the overarching purpose of both HHQI and the Million Hearts® initiative HHQI and the Million Hearts initiative
Identify three (3) key tools from either of the two (2) Cardiovascular Health Best Practice Intervention Packages (BPIPs) that may be appropriate for your agency
Develop two (2) new methods of education to integrate cardiovascular health into your practices
10/23/2014
2
What is HHQI?Goal: Improve the quality of
care home health patients receive
Special Project funded by Centers for Medicare & Medicaid Services
Free evidence‐based tools and resource
Many networking opportunities with 11,000 participants
Phase 3: September 2012 ‒ July 2014Focusing on quality of home health care measured by :
• Reduction of avoidable ACH I i l di i• Improvement in oral medication management
• Improvement of immunization rates• Improvement of cardiovascular health
Continuing HH focus, but all care settings and patients participate
Introducing Underserved Population Network (UP)
Launch of the Home Health Cardiovascular Data Registry
10/23/2014
3
HHQI Phase 4 Focus
Cardiovascular Health
Reducing HospitalizationsReducing Hospitalizations
Chronic Diseases, Falls Prevention & Wound Care
Reducing Disparitiesg p
11 SOW QIN-QIO Map
10/23/2014
4
Home Health Now Part of QIN-QIO Core Work
Home Health is returning to QIO Core Work after 6 year absence after 6 year absence
QINs‐QIOs will be working with limited number of HHAs in each state on the following:– HHQI evidence‐based practices
– Cardiovascular health
– Quality improvement
• Contact your QIN‐QIO immediately
Million Hearts® Initiative
Launched 2011
Co‐Leaders: CDC & CMSCo‐Leaders: CDC & CMS
All settings
Goal: Prevent 1 million heart attacks and strokes by 2017
Million Hearts®
The Million Hearts® word and logo marks, and the Be One in a Million Hearts® slogan and logo marks and associated trade dress are owned by the U.S. Department of Health and Human Services (HHS). Use of these marks does not imply endorsement
by HHS. Use of the Marks also does not necessarily imply that the materials have been reviewed or approved by HHS.
10/23/2014
5
What are the ABCS?
Cardiovascular Disease (CVD) - National
Heart Disease is #1 Heart Disease is #1 f d hf d h
Stroke is #4 cause of Stroke is #4 cause of d hd hcause of deathcause of death deathdeath
1 out of 3 deaths 1 out of 3 deaths related to CVDrelated to CVD
Greatest contributor Greatest contributor to racial disparity in to racial disparity in
George, Tong, Sonnernfeld, & Hong, 2012; Roger VL, et al. Circulation. 2012;125:e2‐e220. & Heidenriech PA, et al. Circulation. 2011;123:933–4
related to CVDrelated to CVDlife expectancylife expectancy
10/23/2014
6
So Why Does it Matter?
HHQI CV Health Improvement Initiative
10/23/2014
7
HHQI Cardiovascular Resources
HHQI National Campaign Website
10/23/2014
8
HHQI National Campaign Website
BPIPs on HHQI Website
10/23/2014
9
Aspirin
Aspirin for Prevention
Risk Factors: Heart AttackAgeDi b t
Risk Factors: StrokeAgeHi h bl dDiabetes
Elevated total cholesterolElevated high‐density lipoprotein cholesterol levelsHigh Blood PressureTobacco useDiet, obesity, physical inactivityAlcohol use
High blood pressureDiabetesTobacco or alcohol use Hx of cardiovascular diseaseOverweight/obesity, physical inactivityHx of TIAs or Sickle Cell disease
AHRQ, 2002; CDC, 2009, Heart Disease Risk Factors; CDC, 2010, Risk Factors for Stroke; Right Diagnosis from healthgrades, 2013; and Erhardt,et al., 2013
Heredity HeredityGender & race
10/23/2014
10
Clinician Fact Sheet
How Do We Add ASA Education to Our Home Health Visits?
10/23/2014
11
Multimedia Tools
3‐minute video by Mayo Clinic AHA’s series of animated pictures with text on 15 different cardiac topics
ASA Campaign Example
10/23/2014
12
Blood Pressure
Risk of preventable death from heart disease
SOURCE:SOURCE: National Vital Statistics System, US Census Bureau, 2008‐2010.
10/23/2014
13
Hypertension ClassificationsHypertension Classification: Stages and Management (JNC 7 Express, 2003, p. 3)
BP Classification *Systolic BP, mm Hg
*Diastolic BP, mm Hg
Lifestyle Modification
Initial Drug Therapy: Without Compelling indications**
Initial Drug Therapy: With Compelling Indications
Normal <120 and <80 Encourage No antihypertensive drug indicated
Drug(s) for compelling indications
Prehypertension 120‐139 or 80‐89 Yes No antihypertensive drug indicated
Drug(s) for compelling indications
Stage 1 hypertension 140‐159 or 90‐99 Yes Thiazide‐type diuretics for most; may consider ACEI; ARB, BB, CCB, or combination
Drug(s) for compelling indications;Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed
Stage 2 hypertension >160 or >100 Yes 2‐drug combination for most*** (usually thiazide‐type diuretic
Drug(s) for compelling indications;Other antihypertensive
and ACEI or ARB or BB or CCB)
drugs (diuretics, ACEI, ARB, BB, CCB) as needed
ASH/ISH guidelines (Weber, et al, 2013), AHRQ, 2002; CDC, 2009, Heart Disease Risk Factors; CDC, 2010, Risk Factors for Stroke; Right Diagnosis from healthgrades, 2013; and Erhardt,et al., 2013
Recommended Lifestyle Modifications for Hypertension ManagementLifestyle Modifications Systolic BP reduction
range (approximated)Links to Patient Tools
Weight Reduction 5‐20 mm Hg / 10 kg of weight loss
Aim for a Healthy Weight : Keep An Eye on Portion SizeAim for a Healthy Weight: Patient Booklet
Adopt DASH eating plan 8‐14 mm Hg At‐a‐glance: Lowering your Blood Pressure with DASH
Recommended Lifestyle Modifications for Hypertension
with DASHYour Guide to Lowering Your Blood Pressure with DASH
Dietary sodium reduction 2‐8 mm Hg Where’s the Sodium?Sodium Tip Sheet
Physical Activity 4‐9 mm Hg Your Guide to Physical Activity and Your Heart
Moderation of alcohol 2‐4 mm Hg Fact Sheet—Alcohol Use and Health
Alcohol and Heart Disease
STOP SMOKING for overall cardiovascular risk reduction
10/23/2014
14
Will your efforts make a difference?
If every elevated systolic blood pressure was reduced by 5 mm Hg, results would include:
14% overall reduction in mortality due to stroke
9% reduction in mortality due to CHD
7% decrease in all‐cause mortality
reduced by 5 mm Hg, results would include:
JNC 7 Complete, 2004
Blood Pressure Assessment
Accurate Blood Pressure Monitoring Pressure Monitoring– Steps for accuracy
– Video and article from New England Journal of Medicine
Blood Pressure Accuracy & Accurately Assessing– Blood Pressure Accuracy & Accurately Assessing Orthostatic Hypotension
10/23/2014
15
Right Equipment is Essential
Compliance Fairs or Annual Field Evaluations
10/23/2014
16
Comprehensive Post-Tests
Blood Pressure Self-Monitoring
Ambulatory Blood Pressure M it iMonitoring– Regular measurement of BPoutside of clinical setting
– Example – home monitors
10/23/2014
17
BP Cuff Wish Card
Bulletin Boards
Sample design
Word document with sample text
10/23/2014
18
Cholesterol
Cholesterol Data
aat least 1 of 3t least 1 of 3
4545%%Adults with diagnosed or undiagnosed: 4545%%
2 of 32 of 3
1313%%
gHypertension
Hypercholesterolemia
Diabetes
1313%%3 of 3 3 of 3
33%%
10/23/2014
19
Patient Engagement
Cholesterol Education Videos
10/23/2014
20
Game Time
10/23/2014
21
Smoking Cessation
Smoking
Most important preventable cause of premature death in US
Increases risk of developing many chronic disorders –including atherosclerosis, leading to MI & stroke
p
AHA, 2012
Controlling/ reversing atherosclerosis is an important to preventing future heart attacks and strokes
10/23/2014
22
Ch D id if iSet a QUIT
Smoking Cessation: AHA 5-step Process
Choose a method for
quitting
St ki
Decide if using medication might help
QDate& sign a no‐smoking
contract
M k l f Stop smoking on your QUIT Day
AHA, 2011
Make a plan for your QUIT Day
“How am I suppose to do smoking cessation and everything else?”
10/23/2014
23
Smoking Smoking JoeJoe
The Story of Smoking Joe
10/23/2014
24
Bulletin Boards
Sample design
Word document with sample textWord document with sample text
Health & Wellness
10/23/2014
25
Health Screenings
Employees Smoking Cessation
Do you or insurance plan offer convenient cessation programs?cessation programs?
How about your HHCAHPS? Do you ever receive complaints or request for non‐smokers?
Is your organization considering a no‐smoking policy at the office?
10/23/2014
26
Agency Wellness
BMI, Cholesterol, & BP monitoring
Weight Watchers at Work
Activity logs
Lunchtime walks
Zumba after work
Running programs
“Bi L ”
Healthy snacks
Food tips
Recipe exchanges
Office salad bar
“Biggest Loser” Competitions
OLA ALA
10/23/2014
27
Employee Support
Insurance Premiums
10/23/2014
28
Staff Games/Group Discussions
Jeopardy type games with facts on ABCSCompetency Fairsp y– Include activities to guess facts with prizes
• How many mm Hg reduction will reduce a person’s mortality due to stroke by 14%?
Contests– Individuals or teams
• Name the risk factors for MI &/or Stroke
Scenarios and discuss intervention strategies– Including non‐adherent patient and physician scenarios
Bulletin boards, quizzes, and podcast
Multidisciplinary Approach for Blood Pressure Control
10/23/2014
29
Leadership
• State agency expectation of who and when are to assess BP• Establish standardized protocols related to BPs and other ABCSPolicies & p• Revise parameter standards (e.g., < 150/90 or less)• Modify EHRs for easy access to trending vital signs• Use standardized communication systems and tools (e.g., SBAR)
Policies & Procedures
• Ensure all staff have access to accurately working equipment• Accommodate for hearing impairments• State agency expectations for routine cleaning, inspections, and testing
Equipment
Leadership
• Create a sense of urgency for integrating preventable CV healthCardiovascular
• Select appropriate resources• Use games, skits, etc. at staff meetings to convey importance
Prevention Culture
• Assign staff member to abstract and enter HHCDR datad hl d h l h ffC di l • Review HHQI data monthly and share results with staff
• Use PDSA cycles to assess and modify CV interventions (start small and build)
Cardiovascular Health Data
10/23/2014
30
Nursing
• Validate that each nurse has right size equipment• Ensure BPs correctly – sounds simple but not always done• Assess vital sign trending each visit – all disciplines
Accurate Assessment • Assess vital sign trending each visit – all disciplines
• Ask for patient specific parameters or utilize agency standardize protocols
• Use standardized effective communication methods (e.g., SBAR)
Communicating with Physicians & Practitioners
• Teach all lifestyle modifications often through out episode of care• Acknowledge that these modifications will effect most chronic diseases
Lifestyle Modification Education
Therapy
• Establish home exercise program & provide safety educationPT
Take BPs on all visits
Obtain SN referral
• Provide postural syncope education, especially with bathing
• Teach self‐management of medications to improve adherence
OT
Obtain SN referral for further assessment and education, if needed
Teach self‐management of
• Evaluate, treat, and teach on swallowing issues with pills/fluids
• Teach cognitive skills to improve adherence to medications
SLPg
medications to improve adherence
10/23/2014
31
Ancillary Staff
• Build community resourcesf d b k l
Social • Create food bank lists• Connect with local faith organizationsWorker
• Educate on cardiac health including diet• Check BP accuracy and parameters on careHHA • Check BP accuracy and parameters on care plans
• Teach s/s to report
HHA
Home Health Cardiovascular Data Registry
10/23/2014
32
Home Health Cardiovascular Data Registry (HHCDR)
Aligns with physician quality measures (PQRS)Aligns with physician quality measures (PQRS)
Includes patients with the following:– Hypertension
– Ischemic Vascular Disease
– Dyslipidemia
– Tobacco use
HHQI Phase 4 Focus
Cardiovascular Health
Reducing HospitalizationsReducing Hospitalizations
Chronic Diseases, Falls Prevention & Wound Care
Reducing Disparitiesg p
10/23/2014
33
Next Steps
1. Register for HHQI & Cardiovascular Health Data Registry– www.HomeHealthQuality.org– Stay tuned for Phase 4 Kick‐Off Event info
2. Connect with your state QIN‐QIO or Network Coordinator– QIN‐QIO – see listing
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press‐releases/2014‐Press‐releases‐items/2014‐07‐18 htmlreleases/2014 Press releases items/2014 07 18.html
– Network Coordinator listing ‐http://www.homehealthquality.org/About‐Us/Partners/HHQI‐Network.aspx
Next Steps
3. Review the Cardiovascular Health BPIPs– Begin with Aspirin and Blood Pressure Controlg p
– Determine if BPs are being taken accurately and consistently
4. Connect with HHQI through Social Media– Facebook, LinkedIn, Twittter, MY HHQI Blog, Live Chat
– www.HomeHealthQuality.orgy g
10/23/2014
34
Questions?
67
Thank You!
Contact Information:
Ci d S @ iCindy Sun – csun@wvmi.org
Misty Kevech – mkevech@wvmi.org
Crystal Welch – cwelch@wvmi.org
And of course, we can always be reached at , y
HHQI@wvmi.org
10/23/2014
35
HHQI
www.HomeHealthQuality.org
This material was prepared by Quality Insights, the Quality Innovation Network‐Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication Number: 11SOW‐WV‐HH‐MMD‐091514