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Senior Centered Care Programming for Older Adults

Senior Centered Care Programming for Older Adults. Excellus August 13, 2009. Senior Volume 65+. UCL. +2 Sigma. +1 Sigma. Average. -1 Sigma. -2 Sigma. LCL. Mean Volume Age 19-64 (Excluding Maternal/Child). 704. 654. 604. 580.3. 554. 540. 520. 505. 504. Senior Volume 65+.

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Senior Centered Care Programming for Older Adults

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  1. Senior Centered CareProgramming for Older Adults Excellus August 13, 2009

  2. Senior Volume 65+ UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL Mean Volume Age 19-64 (Excluding Maternal/Child) 704 654 604 580.3 554 540 520 505 504 Senior Volume 65+ 454 404 354 304 254 Jul-08 Jul-06 Jul-07 Oct-08 Apr-09 Oct-06 Oct-07 Apr-06 Apr-07 Apr-08 Sep-08 Nov-08 Dec-08 Jan-09 Jun-09 Aug-08 Jan-06 Jun-06 Sep-06 Nov-06 Dec-06 Jan-07 Jun-07 Sep-07 Nov-07 Dec-07 Jan-08 Jun-08 Aug-06 Aug-07 Feb-09 Mar-09 May-09 Feb-06 Mar-06 May-06 Feb-07 Mar-07 May-07 Feb-08 Mar-08 May-08 Adult Volume (Seniors = 65+)

  3. Avg Daily Census UCL +2 Sigma +1 Sigma Average -1 Sigma 119.89 -2 Sigma LCL Mean Avg Daily Census Age 19-64 (Excluding Maternal/Child) 109.89 99.89 91.31 Average Daily Census 89.89 84.93 82.27 79.89 69.89 59.89 Jul-07 Jul-06 Jul-08 Oct-08 Apr-09 Oct-06 Oct-07 Apr-06 Apr-07 Apr-08 Jan-09 Jun-09 Jan-06 Jun-06 Jan-07 Jun-07 Jan-08 Jun-08 Feb-09 Mar-09 Feb-06 Mar-06 Feb-07 Mar-07 Feb-08 Mar-08 Nov-08 Dec-08 Sep-08 Sep-06 Nov-06 Dec-06 Sep-07 Nov-07 Dec-07 Aug-06 Aug-07 Aug-08 May-09 May-06 May-07 May-08 Adult Average Daily Census

  4. Senior Services Programming and Integration To assess and improve the interdisciplinary, comprehensive processes of care for seniors using the Crouse Hospital care network, paying particular attention to geriatric syndromes and other issues unique to seniors accessing healthcare. Complication Prevention Maintaining Function Care Transitions

  5. Care Transitions • Goal – Improve the patient’s ability to self manage chronic conditions • Global Outcomes • Reduce readmissions • Enhance patient satisfaction/loyalty • Ready Crouse for healthcare reform • Eric Coleman, MD University of Colorado

  6. Why do patients return to the hospital?

  7. Care Transitions Process • Community-dwelling patients with congestive heart failure / atrial fibrillation • Patient visited early in hospital admission • Home visit within 72 hours • Phone calls on days 2, 7, 14, and 30

  8. Reduce the 30 day readmission rate of CHF patients in the program to below 9.71% (the hospital mean)

  9. Care Transitions - Medication Discrepancies Med Discrepancies UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL 16 14 12 10 8 # of Med Discrepancies 6 5.17 3.73 4 2 0 2/15/2009 2/28/2009 3/15/2009 3/30/2009 4/15/2009 4/30/2009 5/15/2009 5/31/2009 4/15/2008 4/30/2008 5/15/2008 5/31/2008 6/15/2008 6/30/2008 7/15/2008 7/31/2008 8/15/2008 8/31/2008 9/15/2008 9/30/2008 1/31/2009 1/15/2008 1/31/2008 2/15/2008 2/29/2008 3/15/2008 3/31/2008 1/15/2009 10/15/2009 10/31/2009 11/15/2009 11/30/2009 10/15/2007 10/31/2007 11/15/2007 11/30/2007 12/15/2007 12/31/2007 12/15/2009 12/31/2009

  10. Patient Satisfaction with the Care Transitions Program Question: "I was very satisfied with the Care Transitions Program" Patient Satisfaction UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL 4.00 3.63 3.50 3.00 2.50 Patient Satisfaction Score 2.00 1.50 1.00 0.50 0.00 1/31/2009 2/28/2009 3/30/2009 4/30/2009 5/31/2009 3/15/2008 3/31/2008 4/15/2008 4/30/2008 5/15/2008 5/31/2008 6/15/2008 6/30/2008 7/15/2008 7/31/2008 8/15/2008 8/31/2008 9/15/2008 1/15/2008 1/31/2008 2/15/2008 2/29/2008 9/30/2008 12/31/2009 11/30/2009 10/15/2007 10/31/2007 11/15/2007 11/30/2007 12/31/2007 10/31/2009

  11. Resource Utilization 100 CHF/Afib patients examined 1/2007 – 9/2008 • 285 encounters • Average # admits = 2.85 • Total cost = $1,958,197 All inpatient and outpatient visits related to CHF or Afib

  12. Financial Impact(1/2007 – 9/2008) 100 patients studied *Admissions any time in study period ED & inpatient visits

  13. Patients with Multiple Visits Before Intervention 45 patients *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

  14. Patients with Multiple Visits Before Intervention 19 Patients w Subsequent Admissions *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

  15. Days to Readmission 26 Patients with Multiple Admissions before CT Intervention & no readmits after intervention Avg. days to rehospitalization before intervention = 86 Avg. days out of hospital after intervention = 175

  16. Patients Enrolled During First CHF Admission 55 Patients *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

  17. Patients Enrolled During First CHF Admission N= 55 / 11 with Subsequent Admissions* *Admissions any time 1/2007 – 9/2008 ED & inpatient visits

  18. Sharing Our Success University of Rochester Bassett Thompson Health Healthcare Advisory Board Cardiovascular Roundtable Health Quest, Poughkeepsie, NY Glens Falls Hospital Bronson Hospital, Kalamazoo, MI Christiana Care Ocean Medical Center, NJ Wheaton Franciscan Healthcare Alegent Health/Immanuel Health Systems OSF Franciscan Morton Plant Mease Health Care St. Francis Hospital, Tulsa, OK

  19. Sharing Our Success American Hospital Association Wall Street Journal HANYS Annual meeting Dept of Health -- Patient Centered Care Northeast Home Care Nurses Association American Heart Association Regional meeting IPRO Teleconference HC Pro Teleconference

  20. What’s Next? • Complex elders with multiple comorbidities • Transitional Care – Mary Naylor, PhD, RN University of Pennsylvania • COPD, frequent ED visitors, diabetes – good possible populations

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