Home Telehealth and Acute Care Hospitalization ACH

1
Home Telehealth and Acute Care Hospitalization
(ACH)

December 8, 2005 Conference Call Patricia
Burt, RN, BSN, CPHQ Clinical Quality
Specialist?Home Health Health Services Advisory
Group (HSAG)
2
Objectives

• Relate the use of the Home Telehealth Reference
  2005 to Acute Care Hospitalization (ACH)
• Identify Home Telehealth as a mechanism to reduce
  ACH
• Understand how to incorporate OBQI into quality
  improvement (QI) work
• Explain the Culture Change Survey and its
  importance in the development of future Plans of
  Action (POAs)

3
Health Information Technology (HIT)

• HIT supports
• Performance measurement
• Patient management, point-of-care decision-making
  
• Personal health management
• Functionaltransforms performance
• Relevant technologies
• Full electronic health records (EHRs) or personal
  health record
• E-prescribing, computerized physician order entry
• Medication bar-coding
• Telehealth

4
Telehealth Defined

• Phone monitoring
• Telemonitoring

5
Telehealth Manual

• Distributed to all in Identified Participant
  Group (IPG) for Telehealth
• Contentsreview of manual

6
Telehealth and ACH POA

• Use ACH Change Package
• Add on interventions your HHA will use for
  telehealth
• Schedule phone calls three times per week to
  patients identified with three or more high-risk
  factors
• Phone calls will address s/s for diagnoses to
  assess patients status
• Interventions dependent upon results of phone call

7
Telehealth POA and Heart Failure (HF) Example

• Statement
• Nurse is not assessing patient for s/s
  worsening HF between visits
• Education for HF patients does not correlate
  between symptom manifestation and adherence to
  medications, diet, exercise, etc.

8
Telehealth POA and HF(continued)

• Best Practice Statement
• All patients with a diagnosis of HF on the POC
  will have phone monitoring two to three times per
  week (alternate with on-site visits).
• Phone calls will assess current status and
  reinforce education on HF.

9
Telehealth POA and HF(continued)

• Best Practicesapplied
• Nurse will contact patient at (time) and ask
• What was your weight today?
• Do your ankles seem swollen? Do you have trouble
  breathing?
• Did you take (name meds) since last we spoke?
• What food have you eaten? How was it prepared?
  What did you add to your food?
• Other questions pertinent to the patient.

10
Telehealth POA and HF(continued)

• Best Practicesapplied
• Dependent upon responses, nurse will
• intervene per physician orders and/or
• correlate responses to further patient education
• Weight is up 3 lbs, patient had canned soup,
  ankles swollen, increased SOB.
• Do you see how the increased salt/sodium
  affected your weight, breathing and ankles? I am
  going to contact Dr___ Further educate and
  determine next steps.

11
Telehealth POA and HF(continued)

• Intervention Actions (IAs)
• Draft policy/procedure (PP) for phone monitoring
  to include staff reimbursement and paperwork
• Identify staff that will perform monitoring
• Educate staff at all staff meetings
• Role play sample scenarios

12
Telehealth POA and HF(continued)

• Monitoring IAs
• PP approved PAC, BOD
• Recruited staff will be monitored and maintain
  open communication
• Log all HF patients for tracking
• Track attendance at meetingeducate those not in
  attendance
• Review all phone intervention documentation
• Provide feedback on all results

13
Telehealth POA and HF(continued)

• Monitoring
• Review all HF charts for ongoing patient status
  and phone monitoring effectiveness
• Determine effectiveness of IAs for POAadd new
  IAs?
• Review POA for effectivenessmodify?
• Track results of HF patients (prior versus
  current) for access to hospital

14
Transform Organizational Culture

• Senior Leadership
• Orients the organization to quality
• Goals
• Drive resource allocation
• Performance assessment
• Engages staff on quality

15
Transform Organizational Culture (continued)

• Staff
• Empowered to identify quality issues
• Fix mistakes as they occur
• Improve process

16
Transform Organizational Culture (continued)

• Management
• Recruits effectively
• Promotes effective teamwork and communication
• Shares information
• Learns

17
Culture Change

• Survey will be sent in 2006
• Request surveyuse variety of staff
• Share results with HSAG
• Aggregate results to determine areas of
  improvement
• Develop POA based on findings

18
Culture Change Domains

• Guiding model for QI
• Leadership demonstration of commitment to quality
• Team approach to care
• Communication
• Patient-centered care
• Care coordination

19
Culture Change POA

• Identify area of concentration and develop plan
  to improve
• Focus on improving communication across continuum
  of careinternal/external

20
HSAG Assistance

• Identify areas of concentration
• Guide development of POA
• During development
• Review upon completion
• Ongoing

21
Questions?
22
Contact Information

• Marianne Canady, RN, BSN, MA, CPHQ, CCM
• Director, Sub-Acute/QI Program
• 602.665.6113 mcanady_at_azqio.sdps.org
• Patricia Burt, RN, BSN, CPHQ
• Clinical Quality SpecialistHome Health
• 602.745.6284 pburt_at_azqio.spds.org
• Colleen Angotti
• Administrative Assistant II
• 602.745.6295 cangotti_at_azqio.spds.org