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“ See You in Seven” What’s Happening in Cardiac Rehab

“ See You in Seven” What’s Happening in Cardiac Rehab. Heather Shuster, MS Manager, Population Health & Wellness Genesis HealthCare System, Zanesville, Ohio Lean Six Sigma – Green Belt. Hospital to Home (H2H).

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“ See You in Seven” What’s Happening in Cardiac Rehab

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  1. “See You in Seven”What’s Happening in Cardiac Rehab Heather Shuster, MS Manager, Population Health & Wellness Genesis HealthCare System, Zanesville, Ohio Lean Six Sigma – Green Belt

  2. Hospital to Home (H2H) The H2H national quality improvement initiative is an effort to reduce cardiovascular-related hospital readmissions and improve the transition from inpatient to outpatient status for individuals hospitalized with cardiovascular disease.  The H2H initiative is co-led by the American College of Cardiology (ACC) and the Institute for Healthcare Improvement (IHI).

  3. Hospital to Home (H2H) H2H Goal: To reduce all-cause readmission rates among patients discharged with heart failure or acute myocardial infarction by 20% by 2012.

  4. Hospital to Home (H2H) Why choose H2H? • Nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge, with heart failure listed as the common reason for readmission. • In 2004 alone, the total cost of these readmissions was $17.4 billion. • CMS reimbursement dependent on readmission rates

  5. Hospital to Home (H2H) “Right now hospitals, are not penalized if there are constant readmission rates from patients that have gone through the hospital.”

  6. Hospital to Home (H2H) H2H Focus H2H will focus on three main domains that provide opportunities for improvement: • Medication Management Post-Discharge: Is the patient familiar and competent with their medications and do they have access to them? • Early Follow-Up: Does the patient have a follow-up visit scheduled within a week of discharge and are they able to get there? • Symptom Management: Does the patient fully comprehend the signs and symptoms that require medical attention and who to contact if they occur?

  7. H2H: “See You In Seven” Hospital to Home (H2H) have gathered expertise and experience around the “See You in Seven” (SY7) program, proven to reduce unnecessary hospital readmissions and improve transitions of care for patients with CHF, AMI and PTCA/PCI. The goal of SY7 is for all patients discharged with these diagnoses to start cardiac rehab or be seen at follow-up clinic within 7 days of discharge.

  8. H2H: “See You In Seven” Implementing a successful program: • Find your Champions (RNs, Drs., Managers etc.) • Develop inpatient process/staffing matrix for educating patients (Navigators, Nurse Educators) • Create learning/teaching tools 4. Develop process for scheduling and referring to follow-up clinic or Cardiac Rehab programs

  9. H2H: “See You In Seven” • Find your champions (RNs, Drs., Managers etc.) - Create a committee of RNs, Drs., Managers etc. to work on developing, implementing and supporting the project. - Buy-in from the nursing staff as well as managerial/physicians is imperative to making this program successful. • Develop an inpatient process/staffing matrix for educating patients (e.g. Navigators, Nurse Educators) - Less teaching for admission and discharge nurses - Navigators or Nurse Educators provide "survival skill" teachings to patients while in hospital - Set up appointment with clinic or cardiac rehab - Ensure patient compliance with follow-up appointment in clinic and/or cardiac rehab

  10. H2H: “See You In Seven” 3. Create teaching pathways/outline to ensure standardized teaching methods and information are provided to every patient - Create patient take-home folder with educational resources/materials - Quality teaching and learning time is established with patient - Increased understanding of the materials and compliance post- discharge 4. Develop process for scheduling and referring to follow-up clinic or cardiac rehab programs - Create standardized process for scheduling and referring to outpatient services - Discuss, resolve and document any barriers to keeping appointments - Patient provided with appointment reminder (e.g. Appt card) to increase compliance - Follow-up clinic or cardiac rehab program establishes appointment slots for SY7 patients

  11. H2H: “See You In Seven”Success Measures and Strategies The hospital discharge process is successful if: • HF, AMI and PCI patients are identified prior to discharge • Clinic or cardiac rehab appointment within 7 days is scheduled and documented in the medical record • Patient is provided with documentation of the scheduled appointment (e.g. appointment card). • Date, time, location, provider contact information. • Possible barriers to keeping appointment are identified in advance, addressed, and documented in the medical record

  12. H2H: “See You In Seven” The follow-up clinic or cardiac rehab appointment is successful if: • Patient arrives at appointment within 7 days of discharge from hospital • Discharge summary (including summary of hospitalization, updated medication list) available to follow-up provider. • Patient brings his/her medications or a medication list to appointment • Reason for referral available to cardiac rehab and patient brings referral or provider prescription.

  13. H2H:“See You In Seven”Implementation in the Cardiac Rehab Setting Example process for transitioning patient from inpatient to outpatient: • Navigator calls to schedule appointment with CR for patient within 7 days of discharge • CR staff opens appointment time and schedules SY7 patient • After patient is discharged, CR staff will contact patient to check up and remind patient to bring medications to appointment • CR staff calls patient to remind them of appt (1 day prior) • Patient arrives at CR at appointment time with medications • Patient is oriented to the program and exercise equipment. • Patient is placed on a restricted exercise prescription for the first week to allow for ample healing time and then will be transitioned for normal progression.

  14. H2H:“See You In Seven” Outcomes This is a new initiative for H2H due to the pending CMS reimbursements. H2H Outcomes are still being assessed.

  15. Supporting Research:AHA -Circulation (Reuters Health) – December 28, 2012 • “Scheduling heart patients’ first cardiac rehabilitation session within 10 days of hospital discharge gets more of them to show up…” • “Researchers found the earlier scheduling led to 18% increase in attendance at the first orientation appointment compared to appointments scheduled a month or more after discharge” • Case Study: 148 randomized heart patients from Henry Ford Hospital in Detroit • 74 patients received appointments on average 8.4 days after discharge • 77% attended orientation appointment (n=57) • 74 patients received appointment on average 42 days after discharge • 59% attended orientation appointment (n=44) • Dr. Quinn Pack, study lead author stated – • “I think what actually happens is people go home and they’re scared to exercise and (they) go back to their dietary habits…and you are not able to capitalize on that habit change initiative.” • Dr. Frank Richeson, Director of cardiac rehabilitation at the University of Rochester Medical Center in New York stated – • “I was surprised that we didn’t know that already. Recruitment early when the iron is hot makes a lot of sense intuitively.”

  16. Genesis Heart & Vascular Rehab2011 Lean Six Sigma Project – Increase units charged Goal - Increase the percentage of average YTD charged units in Cardiac Rehab from –3% in August to 0% by December 31, 2011 as compared to 2010 charged units • Developed new scripting for scheduling eligible patients • Revised all handout materials to increase compliance • Charging for three 30 minute education classes that were previously not charged for (CPT 93797) • Started H2H “See You in Seven” Program • Wellness Coaching Sessions (3 units) for eligible clients • Working with IT to utilize EPIC for eligible patient lists and automatic order sets

  17. Genesis: “See You In Seven” • Started in August 2011 • Champions: • Nurse Navigators (2012) • Heart & Vascular Diagnostics (Phase I) • HVR Medical Director • Administration • Lean Six Sigma

  18. Genesis: “See You In Seven”Example of SY7 Referral to HVR • Patient identified by AMI/PCI/HF Navigators • Patient educated on benefits • Navigator calls HVR program to schedule • Appointment scheduled within 7 days of discharge and documented in medical record. (Automatic order on all cardiac patients in EPIC) • Educator provides patient with appointment card • HVR program contacts patient to complete paperwork following discharge • HVR program calls patient 1 day prior to appointment as a reminder ** Navigators would be following-up with patient as well to ensure compliance.

  19. Genesis: “See You In Seven”Implementation Outcomes 60 pts. 66 pts. 73 pts. 97 pts.

  20. Genesis: “See You In Seven”

  21. Genesis: “See You In Seven” Sept – $2,666 Oct – $4,136 Nov – $11, 042 Dec - $26, 086

  22. Genesis HVR Trends - Monthly Charged Units Phase I Educators – consistent staff Navigators Hired

  23. Genesis: “See You In Seven” Avg. Sessions = 35! Avg. Sessions = 30

  24. Genesis: “See You In Seven”

  25. Genesis: See You In SevenOutcomes • Average METs increase = 34% • 100% had follow-up exercise plan documented • Average change in waist measurement = 1 inch • SY7 clients with weight loss goals lost on average 2 lbs. • One client lost 17 lbs. Financial Impact (Jan-June 2013) Total HVR Program profit = $37,026.80

  26. The NEW Genesis HVR Gym

  27. From the mouth one of our cardiologist to the wall of the gym…

  28. Genesis Heart Failure Exercise Program Clients learn how to be more physically active and feel better with exercise while successfully learning to improve their quality of life with heart failure. This self-pay program includes: • Exercise and education sessions • Intermittent EKG monitoring • Weight monitoring The goals of the program include: • Improve quality of life • Decrease risks associated with HF • Decrease additional hospital stays • Learn sustainable lifestyle changes

  29. “GOING THE DISTANCE WITH P.A.D.” • This self-pay program includes: • Exercise and education • Treadmill walking and strength training • One on one health assessment • The goals of the program include: • Relieve symptoms of P.A.D. • Improve walking capacity • Decrease risks associated with P.A.D. • Improve quality of life Clients learn how to be more physically active and feel better with exercise while successfully learning to improve their quality of life with peripheral artery disease.

  30. “Get a GRIP on your lifestyle” (GRIP) • Goals of the program: • Reduce risk factors • Education • Lifestyle modification • Improved quality of life Clients who are at risk for chronic diseases such as diabetes, coronary artery disease, stroke etc. can begin the journey to life long lifestyle changes.

  31. Diabetes Exercise Program Learn how to be active and feel better with exercise while successfully controlling your blood sugars to get the most out of your workout Goals of the program: • Regulate blood glucose • Improved understanding of diabetes self-management • Improved endurance and muscle strength • Decreased cardiovascular risk • Improved quality of life

  32. Additional Resources: http://h2hquality.org Heather Shuster, MS Manager, Population Health & Wellness Genesis HealthCare System Zanesville, Ohio 43701 hshuster@genesishcs.org (740) 454-4086

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