ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization

1. ReACH NationalDemonstration CollaborativeReducing Acute Care Hospitalization Overview Penny H. Feldman, PhD ReACH Principal Investigator Visiting Nurse Service of New York Center for Home Care Policy and Research

2. 2 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

3. 3 ReACH Partnership Model

4. 4 Background PAQH: a unique collaboration among home health care organizations to advance the quality of home care for key clinical issues affecting vulnerable populations. During the Diabetes Learning Collaborative, agencies successfully integrated system-level changes and codified key improvements for diabetes patients across their agencies. The lessons learned from this Collaborative directly inform the efforts for the ReACH Collaborative (Optional: ___agencies within the __ (state) participated in the ACH pilot). The initiative resulted in a set of evidence-based change strategies and an improvement framework that have been adapted for implementation during the ReACH Collaborative The lessons learned from this first collaborative � regarding development and implementation of change strategies, training and technical assistance needs, and measurement and evaluation efforts � will inform the efforts of the ReACH Collaborative. PAQH: a unique collaboration among home health care organizations to advance the quality of home care for key clinical issues affecting vulnerable populations. During the Diabetes Learning Collaborative, agencies successfully integrated system-level changes and codified key improvements for diabetes patients across their agencies. The lessons learned from this Collaborative directly inform the efforts for the ReACH Collaborative (Optional: ___agencies within the __ (state) participated in the ACH pilot). The initiative resulted in a set of evidence-based change strategies and an improvement framework that have been adapted for implementation during the ReACH Collaborative The lessons learned from this first collaborative � regarding development and implementation of change strategies, training and technical assistance needs, and measurement and evaluation efforts � will inform the efforts of the ReACH Collaborative.

5. 5 Context ~8100 Medicare-certified HHAs; ~3.4m discharges Mandated �OASIS� assessments & publicly reported outcomes Impending pay for performance <20% 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

6. 6 ReACH Project Goal The Collaborative is designed to test, implement and spread key strategies to reduce hospitalization for all patients �at-risk� in participating agenciesThe Collaborative is designed to test, implement and spread key strategies to reduce hospitalization for all patients �at-risk� in participating agencies

7. 7 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-Assessment-Recommendation (SBAR))

8. 8 ReACH Evaluation

9. 9 ReACH Process Results

10. 10 ReACH Process Results

11. 11 ReACH Process Results

12. 12 ReACH Hospitalization Results Home care episodes resulting in acute care hospitalization for target group:

13. 13 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%)

14. 14 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

15. 15 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

16. 16 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