Patient-Centered Strategies for HCAHPS Improvement

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© Planetree 2013 Patient-Centered Strategies for HCAHPS Improvement Presenter: Michael Lepore, PhD, Director, Research , Quality and Evaluation, Planetree May 8, 2013

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Transcript of Patient-Centered Strategies for HCAHPS Improvement

Page 1: Patient-Centered Strategies for HCAHPS Improvement

© Planetree 2013

Patient-Centered Strategies for HCAHPS Improvement

Presenter: Michael Lepore, PhD, Director, Research , Quality and Evaluation, Planetree

May 8, 2013

Page 2: Patient-Centered Strategies for HCAHPS Improvement

© Planetree 2013

Overview

• HCAHPS Basics

• Patient Experience as a Healthcare Priority

• From Improving HCAHPS Scores to Changing the Culture of Care Delivery

• Patient-Centered Strategies for HCAHPS Improvement

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© Planetree 2013

HCAHPS 101 Hospital Consumer Assessment of Healthcare Providers and Systems

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© Planetree 2013

HCAHPS 101

• A tool that asks patients about their hospital experiences

• A method for collecting standardized patient experience data

• A method for adjusting data for equitable comparisons and benchmarking

• A mechanism for publicly reporting results

• Incentives for using to improve hospital quality of care

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© Planetree 2013

• Dec. 2012 publicly reported scores are based on more than 2.9 million completed surveys from patients at 3,892 hospitals

• Every day more than 7,900 patients complete the HCAHPS survey

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© Planetree 2013

Improving the patient experience is a priority

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© Planetree 2013

HCAHPS and the Quality Connection

“HCAHPS performance is more predictive of readmission rates than the objective clinical performance measures often used to assess the quality of hospital care.”

Boulding et al. in American Journal of Managed Care, 2011

“Two overall measures of hospital performance, the overall rating of the hospital and willingness to recommend the hospital, had strong relationships with better technical performance in processes of care related to pneumonia, CHF, myocardial infarction, and for surgical care.”

Isaac et al. in Health Services Research, 2010

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© Planetree 2013

Elevating the importance of patient experience measures

Value-Based Purchasing:

Transition from pay for reporting to pay for performance

• Points earned for:

– Achievement

– Improvement

– Consistency (HCAHPS)

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© Planetree 2013

2013 Value Based Purchasing Domains

• AMI

• Heart Failure

• Pneumonia

• Surgical Care Improvement

• Healthcare Associated Infections

Clinical Process of Care Domain

(12 measures)

• HCAHPS measures

• 7 composites & 1 global measure

• Does not include Likelihood to Recommend

• Quiet at Night and Cleanliness rolled into one composite

Patient Experience of Care Domain

(8 measures)

70%

30%

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© Planetree 2013

Proposed 2014 Value Based Purchasing Domains

25% Outcomes

45% Clinical Process of Care

30% Patient Experience of Care

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© Planetree 2013

HCAHPS Performance 30% of Total

National Median VBP Score 54

Score Needed to Maximize Medicare Reimbursements Under VBP

70

National Median Score on Clinical Measures

64

Score on Clinical Measures Needed to Maximize Reimbursement

81

National Median HCAHPS Score 21

HCAHPS Score Needed to Maximize Medicare Reimbursements

61

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The heart of the matter –

relationships and communication.

“I find that if the doctors would just talk in my terms

instead of these long words, that would help. I

am not a doctor; these words don’t mean nothing

to me.”

-

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© Planetree 2012 © Planetree 2012

A Consistent Finding: It’s All About Culture

• High performing sites credited their success not to specific practices, but to a well-established culture of patient-centered care

• High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement

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© Planetree 2012

Need list of members

From Improving HCAHPS Scores to Changing Health Care Cultures: Planetree

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© Planetree 2012 © Planetree 2012

Individual

Team

Industry Advocate

Solution Provider

Standard

Setter

Who is Planetree?

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Advocating for what patients and caregivers need and want

Compassionate Human Interactions

Access to Meaningful Information

Support & Participation of Family, Friends

Healing Environment

Support for body, mind & spirit

Arts and Entertainment

Spirituality

Caring Touch

Integrative Therapies

Healthy Food and Nutrition

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Planetree Model Components

HCAHPS Categories

Compassionate Human Interactions

Communication with Nurses Communication with Physicians Responsiveness Pain Management Care Transitions Overall Satisfaction and Likelihood to Recommend

Access to Meaningful Information

Communication with Nurses Communication with Physicians Communication about Medications Care Transitions Discharge Instructions

Support and Participation of Family Responsiveness Discharge Instructions

Healing Environment Cleanliness Quiet at Night

Support for Body, Mind and Spirit

Responsiveness Pain Management Quiet at Night Overall Satisfaction and Likelihood to Recommend

Making the Connection

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1) Partner with patients.

2) Create a physical environment that supports your culture.

3) Make data meaningful to staff.

4) Look beyond the hospital setting.

5) Put compassion first.

Patient-Centered Strategies for HCAHPS Improvement

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1. Partner with Patients and Families

Patient Pathways

Shared Medical Records

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77.8%

69%

50%

60%

70%

80%

90%

Yes No

*Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)

Were you told you could read your medical chart?

Ver

y sa

tisf

ied

wit

h t

hei

r o

vera

ll h

osp

ital

exp

erie

nce

?

Patients who are told they could read their medical chart are more likely to be very satisfied with their overall hospital experience

Impact of Shared Medical Record on Overall Patient Satisfaction with Care

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Bedside shift report drives patient satisfaction

82

84

86

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90

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96

Nurses treat youwith

courtesy/respect

Nurses attitudetoward requests

Attention tospecial/personal

needs

Nurses kept youinfromed

Staff include youin decision re:

treatment

Staff workedtogether to care

for you

6 months prior to implementation of bedside report

6 months after implmentation of bedside report

Effects of bedside shift change at a Planetree Designated Hospital

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Partnering with Patients…Beyond the Bedside

• Invite patients to serve on hospital committees and HCAHPS improvement task forces

• Invite board members to round on patients prior to every board meeting

• Invite a patient to share his or her story (what went well, what didn’t go well) to kick off every board meeting

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2. Create a physical environment that supports your culture

“Why is the hospital not as humanely practical in aesthetic effect as it tries to be in physical support?”

Frank Lloyd Wright

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© Planetree 2013

Poor Patient Experience = Post-Hospital Syndrome

CONTRIBUTING FACTORS:

• sleep deprivation

• disruption of normal circadian rhythms

• poor nourishment

• poorly controlled pain and discomfort

• medications that can alter cognition and physical function

• deconditioning due to bed rest or inactivity

Krumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013

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© Planetree 2013

Assess Your Healing Environment/Reduce Stressors

EMOTIONAL SUPPORT • Family overnight accommodations

SLEEP SUPPORT • Quiet Environment/Sleep Menus

NOURISHMENT • Family Kitchens/Access to Food

CONNECTION TO NATURAL ENVIRONMENT • Healing Gardens and Natural Light

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Innovations in the Healing Environment: A Patient-Centered Quiet Campaign

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More Evidence

The use of call lights by patients decreased by 40% following implementation of decentralized nursing stations & 24-hour visitation (Charmel, 2003)

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3. Make data meaningful to

staff.

But remember, the data are not the point, patient experiences are the point!

-

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Making Data Meaningful to Staff

Engage staff (and patients) in the selection of quality measures

Involve staff in performance improvement efforts

Give staff time to participate in improvement efforts

Display data so it is easy to read and standardized

Make staff aware of the data being measured

Discuss in staff meetings

Reinforce with postings and displays

Meredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.

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© Planetree 2013

New HCAHPS Domain: Care Transitions

Mandatory for patients discharged as of Jan. 2013: • Question 1: The hospital staff took my preferences and those

of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital.

• Question 2: When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

• Question 3: When I left the hospital, I clearly understood the purpose for taking each of my medications.

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Patient-Centered Care Transitions

Hospital

Skilled

Facility Home Health

Agency

Physician

Office

Patient

• Same Page Transitions

• Inter-Continuum Collaboratives

• Physician appointments made prior to hospital discharge

• Discharge summary provided to patient and PCP

• Personal Health Records

• Support for family caregivers

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Compassion in Action

VA New Jersey Sleep Menu

Good Samaritan Hospital Patient

Story Board

Physician communication

coaching

Patient Experience training and education for staff- Middle Management Training

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“[The doctor]

came in, pulled

up a chair and

said he wanted

to talk…and we

talked on my

terms.”

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© Planetree 2013

Criteria can be downloaded at www.planetree.org

A Measureable Framework for PCC Culture Change and HCAHPS Improvement

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Planetree Designated Hospitals and HCAHPS performance:

A marker of Quality:

Planetree Designated Hospitals consistently outperform the National Average on HCAHPS since public reporting of scores began.

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Patient's Room and Bathroom Always Kept Clean

Designated Hospital Average National Average

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Responsiveness

Designated Hospital Average National Average

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Note: The difference is statistically significant (p<0.05).

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Patients Given Information About Recovery At Home

Designated Hospital Average National Average

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Staff Always Explained About Medicines

Designated Hospital Average National Average

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CMS Reporting Period

Doctors Always Communicated Well

Designated Hospital Average National Average

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Note: The difference is statistically significant (p<0.05).

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Nurses Always Communicated Well

Designated Hospital Average National Average

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Note: The difference is statistically significant (p<0.05).

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Pain Was Always Well Controlled

Designated Hospital Average National Average

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Patient's Room Always Kept Quiet At Night

Designated Hospital Average National Average

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Note: The difference is statistically significant (p<0.05).

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Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12

CMS Reporting Period

Percent of Patients Highly Satisfied (Overall Rating 9 or 10)

Designated Hospital Average National Average

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Note: The difference is statistically significant (p<0.05).

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CMS Reporting Period

Would Definitely Recommend Hospital to Friends and Family

Designated Hospital Average National Average

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The Bottom Line on VBP and Designation

A preliminary analysis indicates that, as a group, Patient-Centered Designated Hospitals are poised to receive:

•127% in reimbursement revenue

•$770,000(100% of all withheld monies plus additional revenues)

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© Planetree 2012 © Planetree 2012

Resources For Your Journey

Patient-Centered Care Improvement Guide

Patient-Centered Hospital Designation

Criteria

HCAHPS Assessments

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© Planetree 2012 © Planetree 2012

Planetree

130 Division Street

Derby, CT 06418

www.planetree.org

203.732.1365

Michael Lepore, PhD

Director of Quality, Research, & Evaluation

[email protected]

Questions