Clarion Presentation
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Transcript of Clarion Presentation
Think Holistic, Think Patient-Centered, Think FAST!
Yang Chen, Sara Hanrahan, Cathy Ng, Sophia OlsenCLARION Case Competition
Spring 2015
Overview
● Patient Case
● Root Cause Analysis
● Recommendations & Implementation
● Financial Assessment
● Conclusion
Lynette’s Story
Lynette Tate53 yo FemaleDx: Left hemisphere
ischemic stroke
Disease Onset
• Low health literacy • Low awareness of disease prevention
Hospital admission
• Symptoms-centered care• Healthcare team lack communication and coordination Di
scharge/Rehab
• Lack proper patient education on disease state and follow-up care• Lack proper communication between facilities
Homecare
• Failure to receive therapy• Receiving wrong dosage of insulin
Patient’s Health Decline
StrokeNationally
● Kills approximately 130,000 Americans yearly● 4th leading cause of death● $34 billion each year in costs:
o health care serviceso medications o missed days of work
● 87% of all strokes are ischemic strokeso when blood flow to the brain is blocked
● The highest death rates from stroke are in the southeastern US
Kentucky
● Department of Public Health o William D. Hacker, MD, FAAP, CPE
Commissioner● Kentucky Heart Disease and Stroke Prevention
State Action Plan 2011-2016
Kentucky Heart Disease and Stroke Prevention State Action Plan 2011-2016
● Kentucky is plagued with the status of being an unhealthy state.
● It ranks 6th in heart disease and 10th in stroke mortality.
● Focus on the CDC’s priority areas for heart disease and stroke.
● The KHDSP Program partnered with the Northern Kentucky CARE (Cardiovascular Assessment, Risk Reduction and Education) o Designed to provide blood pressure
awareness educational encounters within the community
Our Mission● To deliver care in a holistic,
patient-centered, and outcome-oriented manner ensuring accessibility, reliability, and affordability.
Root Cause Analysis
Problem: ● Non-optimal care
Patient Factors:● Low awareness of
disease state/ symptoms
● Diet/lifestyle● Low health literacy● Miscommunication● Lack of education
Provider Factors:● Not patient-centered● Partial assessment● Delayed intervention● Rushed education
System Factors:● Non-streamlined care● Misconception of care● Lack of care
coordination● Lack of resources
Community Efforts:● Low awareness, no
perceived need● Community
Outreach/Education● Low overall health
Recommendations & Implementation
Patient Factors
Optimal care: ● Help patient to maintain a
healthy lifestyle through diet and exercise
● Preventive care
Our recommendations:● Involve patient in their
therapeutic care plan● Improve patient’s
compliance & understanding
Interventions at Patient Level● Patient/Family Education● Use a plain language● Use teach-back method to confirm patient’s understanding● Tests and screenings
Community Efforts
Optimal care:● Raise awareness of strokes
and its impact● Provide professional advice
to the general public● Encourages the pursuit of
overall wellness in life
Our recommendations:● Community outreach
and education
Interventions at Community Level● Education focus on the modifiable risk factors associated
with stokes, such as cardiovascular disease, high cholesterol, smoking, obesity, hypertension, and diabetes
● Wellness fair● Medication take-back
Provider FactorsOur Recommendations:
● Increase interprofessional communication
● Build trust and foster a good provider-patient relationship
Optimal Care:● Patient-centered care
plan● Interprofessional
communication● Tailored patient education● Thorough assessments● Use of diagnostic studies● Holistic approach to
patient care
Interventions at Provider Level● Hiring a Stroke Specialist● “My Care Board”, highlighting: diet status, tests/screenings
yet to be performed, anticipated discharge date● Multidisciplinary daily rounding
○ Weekly plan of care (POC) meetings● Interprofessional inservices● Emphasis on holistic care
System FactorsOptimal Care: ● Delivery of comprehensive
health care services that are well coordinated
● Good communications among healthcare providers
Our recommendations:● Continuity and
Coordination of care● Follow-up/Transitioning
care
Interventions at System Level
● Unified Electronic Medical Record (EMR)● Having sufficient trained staff for each health
care discipline● Transfer/Discharge Checklists● Home evaluations
Financial Assessment
Why these cost would be good investments?
Initial hospitalizationRehabilitationPhysician CostsHospital ReadmissionMedications and other expenses
43%16%14%14%13%
Breakdown of the direct costs of care for the first 90 days after a stroke:
Model adopted from The Stroke Center at University Hospital, Newark, NJ
Financial Budget+ $ 184,864 (Stroke Specialist Salary x 1)+ $ 61,534 (Occupational Therapist Salary x1)+ $ 65,388 (Physical Therapist Salary x1)+ $ 123,750 (Max. EMR Implementation cost)- $ 110,162 (Aspiration Pneumonia x13) - $ 428,572 (Readmission Rate Savings / year)
---------------------------------------------------------------------------------------------
$ 103,198 in Savings annually!
Contracting ArrangementsTraditional fee for service (Current)• DRG type payment for the initial hospitalization• Negotiated fee schedule with providers
Bundled payment arrangement (Alternative)• Defined amount of money for all of the care
Conclusion
Stroke in South Tree Health Network
Improve performance related to the Triple Aim:● Improve the patient experience
o Clinical quality and patient satisfaction ● Improve the health of the population
o Collaborate with Kentucky Action Plan● Improve affordability of care
o Streamline South Tree Health Network
Moving forward...● Re-assessment of our implementation in 6, 12, 18
months to see if this model is working.● Replicate/modify this model for other chronic diseases like diabetes and hypertension.
Questions