Washington State Hospital Association Safe Table Readmissions July 10, 2013

1. Washington State Hospital AssociationSafe TableReadmissions July 10, 2013 Mara Zabari, Director of Integration – Partnership for Patients Presented at Washington State Hospital Association Safe Table, 7/10/13

2. Safe Tables • Confidential • Safe • All teach • All learn Presented at Washington State Hospital Association Safe Table, 7/10/13

3. Partnership for Patients • 40 – Percent reduction in harm • 20 – Percent reduction in readmissions • 13 – By December 2013 Saving Lives Presented at Washington State Hospital Association Safe Table, 7/10/13

4. 10 Targeted Strategies Infection Reduction: • Catheter-associated urinary tract infections (CAUTI) • Central line-associated blood stream infections (CLABSI) • Surgical site infections (SSI) • Ventilator-associated pneumonia (VAP) Nursing Care: • Injuries from falls and immobility • Pressure ulcers High Risk: • Adverse drug events • Obstetrical adverse events • Venous thromboembolism or blood clots (VTE) Continuity of Care: 10. Prevention of readmissions Cultural Transformation Leadership Engagement Patient and Family Engagement Presented at Washington State Hospital Association Safe Table, 7/10/13

6. Progress Report Second Report Sent Out in June Presented at Washington State Hospital Association Safe Table, 7/10/13

8. Medicaid Quality Incentive http://www.wsha.org/qualityincentive.cfm Presented at Washington State Hospital Association Safe Table, 7/10/13

9. Program Design • One percent inpatient Medicaid rate increase for non critical access hospitals • Time-line: • July 2013 data collection (for most measures) • July 2014 payment to qualifying hospitals • July 2014 recognition for hospitals with all tens on eligible measures • Performance thresholds and payment Hospitals receiving an average score of 5 or above receive the increase Presented at Washington State Hospital Association Safe Table, 7/10/13

10. Measures: Infection Prevention (Acute care, rehabilitation, and pediatric services) Improvement measure: Catheter Associated- Urinary Tract Infection per patient day (hospital-wide) Sustaining measure: Health Care Personnel (HCP) influenza vaccination rate ER is for Emergencies (Adult and pediatric hospitals with emergency rooms only) Improvement measure: percent of patients (all payors) with five or more visits to the emergency room with care plans Safety (Acute care and rehabilitation services ) Improvement measure: Falls with Injury per patient day Presented at Washington State Hospital Association Safe Table, 7/10/13

11. Measures (Cont..) Safe Deliveries: Induction Appropriateness and Elective Deliveries Prior to 39 Weeks (Hospitals with obstetrical programs only) Improvement measure: percent of patients undergoing a medical or non medical labor induction with documentation of consent, Bishop Score, and indication Sustaining measure: percent of patients with Elective Deliveries 37 to less than 39 weeks gestational age Behavioral Health: (Behavioral health hospital or unit) Improvement Measure: percent of patients with post-discharge continuing care plan transmitted Sustaining Measures: • Health Care Personnel (HCP) influenza vaccination rate • Percent of patients discharged on multiple antipsychotic medications with appropriate justification Presented at Washington State Hospital Association Safe Table, 7/10/13

12. Measures (Cont..)Acute, rehabilitation, and pediatric services with emergency room: Readmissions Improvement measure: Pneumonia, Congestive Heart Failure and AMI patients who received: • A plan for follow up care with provider • An updated medication List • Documentation of “teach-back” • Follow-up discharge phone call Presented at Washington State Hospital Association Safe Table, 7/10/13

13. Re-AdmissionsWE are On a Journey

14. General attitudes towards standardization: Lessons learned from an attitude survey “StandardizationPolyannas” “Haters” “Ambivalent”

15. 17.5%decrease from baseline to Q3 2012 Presented at Washington State Hospital Association Safe Table, 7/10/13

16. Why Do People Get Readmitted? Lack of Community Infrastructure for Achieving Common Goals Presented at Washington State Hospital Association Safe Table, 7/10/13

17. Today – Building the Infrastructure Primary & Specialty Care Payors Home (Patient & Family Caregivers) Skilled Nursing, Assisted Living, and AAA Employers Hospital Home Health Presented at Washington State Hospital Association Safe Table, 7/10/13

18. Hospital/Emergency Department Notify PCP: Moderate or High Risk (See Triage Grid) WSHA Transitions of Careto Reduce Patient Readmissions End-of-Life Planning Social/Resources Assessment Patient Education Develop Care Plan Med Reconciliation <24hr >24hr (See Triage Grid) - Schedule Appointment/Follow Up - Send Care Plan PCP Makes Follow Up call Hospital or PCP Makes Follow Up Call Patient Appointment with PCP End-of Life Planning Social/Resources Assessment Reinforce Care Plan Med Reconciliation Patient Education Provider Feedback to Hospital/ ED for Specific Cases In partnership with: Community Review Forum Presented at Washington State Hospital Association Safe Table, 7/10/13

19. What Are We Learning From Our Pilots? • Building community infrastructure • Processes for handoffs • Primary care notification • Scheduling out-patient follow up visit • Discharge follow up • Risk assessment Presented at Washington State Hospital Association Safe Table, 7/10/13

20. Discussion Hospital Skilled Nursing, Assisted Living, and AAA Presented at Washington State Hospital Association Safe Table, 7/10/13