ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization

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ReACH NationalDemonstration CollaborativeReducin
g Acute Care Hospitalization

• Overview
• Penny H. Feldman, PhD
• ReACH Principal Investigator
• Visiting Nurse Service of New York
• Center for Home Care Policy and Research

The project team gratefully acknowledges the
support from AHRQ (1 U18 HS 13694) and the Robert
Wood Johnson Foundation (042588)
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ReACH Structure and Objectives

• Partnership to advance home health care quality
• VNSNY Center for Home Care Policy and Research
  (CHCPR)
• Home care QIOSC Quality Insights of PA
• 16 QIOs
• 169 home health agencies (HHAs) from 20 states
• Objectives
• Test a collaborative model for HHA practice
  improvement
• Reduce acute care hospitalization rates

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ReACH Partnership Model
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Background
2002 Partnership for Achieving Quality Homecare
(PAQH) - Funded by AHRQ and RWJ 2004 PAQH
Diabetes Learning Collaborative - 8
HHAs - Significant improvement in 8 of 9
measures -- 30 percentage point
increase in rate of patients with glucose
in target range 2005 Acute Care Hospitalization
(ACH) Pilot Project - QIOSC and CHCPR
evidence review and best practices 2005-2007
ReACH 2 seven-month waves
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Context

• 8100 Medicare-certified HHAs 3.4m discharges
• Mandated OASIS assessments publicly reported
  outcomes
• Impending pay for performance
• lt20 agencies accredited
• Variable quality/weak quality infrastructure
• Dispersed work force/poor support for frontline
  managers
• No history of voluntary industry partnerships
• CMS-funded Home Health Quality Improvement
  Campaign (HHQI) 2007-2008

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ReACH Project Goal
Reduce acute care hospitalizations of home
health patients and make substantial progress
toward CMS target of 23 risk-adjusted rate
(already achieved by 25 of all HHAs nationwide)
For those agencies with rates at 23 or lower
sustain the rate, and identify ways to reduce it
further
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ReACH Best Practices

• Target group selection (e.g.,region, office,
  dx)
• Risk Assessment
• Emergency Plans and Risk-Appropriate Care Plans
• Front load visits and increase contacts (phone
  calls telemedicine) for high risk patients
• Medication reconciliation
• Improved MD communication (Situation-Background-As
  sessment-Recommendation (SBAR))

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ReACH Evaluation

• Level 1 Perceptions
• Participant satisfaction, challenges, lessons
  learned
• Level 2 Care processes
• Core measures, strategies and actions
• Level 3 Results
• Percentage of episodes ending with
  hospitalization
• Data sources
• On-line surveys phone interviews
• Monthly record reviews data entered on line
• OASIS reports (Home Healthcare Compare)

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ReACH Process Results
Total patients in target group identified at
risk
Target patients with completed risk assessments
17.0
-8.3
46.0
40.6
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ReACH Process Results
Target patients with risk-specific care plans
50.0
44.4
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ReACH Process Results
Average home care visits in first two weeks for
patients at-risk of hospitalization in target
group
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ReACH Hospitalization Results

• Home care episodes resulting in acute care
  hospitalization for target group

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HHQI National ACH Campaign Results

• Comparison of 7,452 Medicare-certified HHAs
• 4,352 Early Participating (EP) Agencies
• 972 Later Participating (LP) Agencies
• 2,128 Non Participating (NP) Agencies
• ACH rate over a 12-month period
• March 2007 February 2008
• EP 30.73 30.48
• LP 32.06 32.33
• NP 34.61 35.39
• HHAs achieving at least 5 improvement
• EP (38.4) LP (37.9) NP (34.6)

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Challenges to ReACH Implementation

• QIOs
• Varied expertise and skills
• Varied agency selection processes
• HHAs
• Varied QI experiences and skills
• Competing priorities
• Staff changes
• ReACH mechanism
• Long-distance faculty
• Reliance on QIOs to transmit skills/knowledge
• Technical issues related to virtual communication
• Evaluation
• Varied target groups
• Varied implementation of varied strategies and
  tools

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Lessons Learned

• QIOs need/demand for TA, tools, support
• HHAs positive response to Collaborative Learning
  model
• Importance of face-to-face information transfer
  (local learning sessions) and TA
• Efficiencies from leveraging QIO resources
• Recruitment, TA, Data
• Value of
• Peer to peer reinforcement, shared experiences
• Web-based data collection
• Central resources
• Leadership involvement key

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Collaboration Next Steps

• Geriatric CHAMP Program
• Promote National Framework to Advance Geriatric
  Home Care Excellence
• Build geriatric capacity in significant number of
  HHAs
• Achieve significant, measurable improvement in
  home care for older persons through
• E-learning programs
• A National Community of Practice to support
  quality improvement and share the Framework
  findings
• Corollary activities and products
• Collaborations (e.g., NAHC, VNAA, state
  associations QIOSCs accrediting bodies
  consumer groups)
• Funding Atlantic Philanthropies, John A.
  Hartford Foundation, California Health Care
  Foundation, New York State Health Foundation,
  others