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Program of All-Inclusive Care for the Elderly Level II Reporting Case Studies

Program of All-Inclusive Care for the Elderly Level II Reporting Case Studies. Anitra Johnson, MSN, BSN, RN LCDR, USPHS Nurse Consultant Michael Leboe, MSW, LCSW LCDR, USPHS Health Insurance Specialist March 7, 2012. PACE Updates. Revising Level II Guidance Incidents and Thresholds

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Program of All-Inclusive Care for the Elderly Level II Reporting Case Studies

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  1. Program of All-Inclusive Care for the ElderlyLevel II ReportingCase Studies Anitra Johnson, MSN, BSN, RN LCDR, USPHS Nurse Consultant Michael Leboe, MSW, LCSW LCDR, USPHS Health Insurance Specialist March 7, 2012

  2. PACE Updates • Revising Level II Guidance • Incidents and Thresholds • Reporting process • Content • Definitions • Sorting and analyzing Level II incidents from January 2011-January 2012 • Improving quality of care

  3. Case Study #1 • 89 year old participant with diagnosis of CVA, COPD, and depression • Participant on palliative care • Seen in PACE clinic on 9/29/11 for 6-month careplan update • Medication filled on 10/29/11; called participant to deliver—no answer and left message • 11/5/11 no contact with family or participant to deliver meds

  4. Case Study #1 (cont’d) • 11/24/11 family calls to report a “rash” on patients back • 11/26/11 participant seen in PACE clinic • Dx with 5 stage IV pressure ulcers, and 4 stage II pressure ulcers • 11/27/11 home care provided for wound care • 12/3/11 participant expired

  5. Discussion • What could the PACE organization done differently? • What could the participant/family done differently? • Were these pressure ulcers preventable? • How can the PACE organization staff be reeducated? • How can the we prevent this from occurring with other participants? • Any lessons learned?

  6. Case Study #2 • 86 year old participant who lives alone fell at home on 10/13/11 • Participant did not attend PACE center on 10/13/11-10/15/11 (Scheduled days to attend PACE center) • History of diabetes and COPD. No history of falls. • Participant was found by home health aide on 10/17/11 on the floor behind the front door

  7. Case Study #2 (cont’d) • Who should be notified at this point?

  8. Case Study #2 (cont’d) • The participant was taken to the Emergency Department via EMS on 10/17/11 • Participant had fractured right hip and fractured ankle • Participant reports she tripped over the rug at the front door. She was attempting to go get the newspaper off the front porch • Participant had hip and ankle surgery and was discharged from hospital on 10/25/11 due to post-operative complications

  9. Case Study #2 (cont’d) • Is there anything the PACE organization could have done differently at this point? • What quality improvement initiatives might the Root Cause Analysis reveal? • Is there a need for further education to the participant, family, or PACE organization?

  10. Contact Information Anitra Johnson, MSN, BSN, RN LCDR, USPHS Nurse Consultant Division of Medicare Advantage Operations (DMAO) 410-786-0609 anitra.johnson@cms.hhs.gov Michael Leboe, MSW, LCSW LCDR, USPHS Health Insurance Specialist Consortium for Medicare Health Plans Operations (CMHPO) 215-861-4215 michael.leboe@cms.hhs.gov

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