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Patient-Centered Strategies for HCAHPS Improvement



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  • 1. © Planetree 2013Patient-Centered Strategiesfor HCAHPS ImprovementPresenter:Michael Lepore, PhD, Director, Research , Quality and Evaluation, PlanetreeMay 8, 2013
  • 2. © Planetree 2013Overview• HCAHPS Basics• Patient Experience as a Healthcare Priority• From Improving HCAHPS Scores to Changing the Cultureof Care Delivery• Patient-Centered Strategies for HCAHPS Improvement
  • 3. © Planetree 2013HCAHPS 101Hospital Consumer Assessment ofHealthcare Providers and Systems
  • 4. © Planetree 2013HCAHPS 101• A tool that asks patients about their hospital experiences• A method for collecting standardized patient experience data• A method for adjusting data for equitable comparisons andbenchmarking• A mechanism for publicly reporting results• Incentives for using to improve hospital quality of care
  • 5. © Planetree 2013• Dec. 2012 publicly reported scores are based on morethan 2.9 million completed surveys from patients at3,892 hospitals• Every day more than 7,900 patients complete theHCAHPS survey
  • 6. © Planetree 2013Improving the patientexperience is a priority
  • 7. © Planetree 2013HCAHPS and the Quality Connection“HCAHPS performance is more predictive of readmission ratesthan the objective clinical performance measures often used toassess the quality of hospital care.”Boulding et al. in American Journal of Managed Care, 2011“Two overall measures of hospital performance, the overall ratingof the hospital and willingness to recommend the hospital, hadstrong relationships with better technical performance inprocesses of care related to pneumonia, CHF, myocardialinfarction, and for surgical care.”Isaac et al. in Health Services Research, 2010
  • 8. © Planetree 2013Elevating the importance of patient experience measuresValue-Based Purchasing:Transition from pay for reporting to pay for performance• Points earned for:– Achievement– Improvement– Consistency (HCAHPS)
  • 9. © Planetree 20132013 Value Based Purchasing Domains• AMI• Heart Failure• Pneumonia• Surgical Care Improvement• Healthcare Associated InfectionsClinical Process ofCare Domain(12 measures)• HCAHPS measures• 7 composites & 1 global measure• Does not include Likelihood toRecommend• Quiet at Night and Cleanlinessrolled into one compositePatient Experienceof Care Domain(8 measures)70%30%
  • 10. © Planetree 2013Proposed 2014 Value Based Purchasing Domains25%Outcomes45% ClinicalProcess of Care30% PatientExperienceof Care
  • 11. © Planetree 2013HCAHPS Performance30% of TotalNational Median VBP Score 54Score Needed to Maximize MedicareReimbursements Under VBP70National Median Score on ClinicalMeasures64Score on Clinical Measures Needed toMaximize Reimbursement81National Median HCAHPS Score 21HCAHPS Score Needed to MaximizeMedicare Reimbursements61
  • 12. The heart of thematter –relationships andcommunication.“I find that if the doctorswould just talk in my termsinstead of these longwords, that would help. Iam not a doctor; thesewords don’t mean nothingto me.”-
  • 13. © Planetree 2012© Planetree 2012A Consistent Finding: It’s All About Culture• High performing sites credited their success not to specificpractices, but to a well-established culture of patient-centered care• High performing sites had implemented a comprehensiveapproach to patient engagement, family involvement andstaff engagement
  • 14. © Planetree 2012Need list ofmembersFrom Improving HCAHPS Scores toChanging Health Care Cultures: Planetree
  • 15. © Planetree 2012© Planetree 2012IndividualTeamIndustry AdvocateSolutionProviderStandardSetterWho is Planetree?
  • 16. © Planetree 2013Advocating for what patients and caregivers need and wantCompassionate Human InteractionsAccess to Meaningful InformationSupport & Participation of Family, FriendsHealing EnvironmentSupport for body, mind & spiritArts and EntertainmentSpiritualityCaring TouchIntegrative TherapiesHealthy Food and Nutrition
  • 17. © Planetree 2013Planetree ModelComponentsHCAHPS CategoriesCompassionate Human InteractionsCommunication with NursesCommunication with PhysiciansResponsivenessPain ManagementCare TransitionsOverall Satisfaction and Likelihood to RecommendAccess to Meaningful InformationCommunication with NursesCommunication with PhysiciansCommunication about MedicationsCare TransitionsDischarge InstructionsSupport and Participation of FamilyResponsivenessDischarge InstructionsHealing EnvironmentCleanlinessQuiet at NightSupport for Body, Mind and SpiritResponsivenessPain ManagementQuiet at NightOverall Satisfaction and Likelihood to RecommendMaking the Connection
  • 18. © Planetree 20131) Partner with patients.2) Create a physical environment that supports your culture.3) Make data meaningful to staff.4) Look beyond the hospital setting.5) Put compassion first.Patient-Centered Strategies for HCAHPSImprovement
  • 19. 1. Partner with Patients and FamiliesPatient PathwaysShared Medical Records
  • 20. 77.8%69%50%60%70%80%90%Yes No*Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)Were you told you could read your medical chart?Verysatisfiedwiththeiroverallhospitalexperience?Patients who are told they could read their medical chart are morelikely to be very satisfied with their overall hospital experienceImpact of Shared Medical Record on OverallPatient Satisfaction with Care
  • 21. © Planetree 2013“Reviewing the chart with someone put meat ease.”
  • 22. Bedside Shift Report
  • 23. Bedside shift report drives patient satisfaction8284868890929496Nurses treat youwithcourtesy/respectNurses attitudetoward requestsAttention tospecial/personalneedsNurses kept youinfromedStaff include youin decision re:treatmentStaff workedtogether to carefor you6 months prior to implementation of bedside report6 months after implmentation of bedside reportEffects of bedside shift change at a Planetree Designated Hospital
  • 24. Partnering with Patients…Beyond the Bedside• Invite patients to serve on hospital committees and HCAHPSimprovement task forces• Invite board members to round on patients prior to every board meeting• Invite a patient to share his or her story (what went well, what didn’tgo well) to kick off every board meeting
  • 25. 2. Create a physical environment that supports your culture“Why is the hospital not as humanely practical inaesthetic effect as it tries to be in physical support?”Frank Lloyd Wright
  • 26. © Planetree 2013Poor Patient Experience = Post-Hospital SyndromeCONTRIBUTING FACTORS:• sleep deprivation• disruption of normal circadian rhythms• poor nourishment• poorly controlled pain and discomfort• medications that can alter cognition and physical function• deconditioning due to bed rest or inactivityKrumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013
  • 27. © Planetree 2013Assess Your Healing Environment/Reduce StressorsEMOTIONAL SUPPORT• Family overnight accommodationsSLEEP SUPPORT• Quiet Environment/Sleep MenusNOURISHMENT• Family Kitchens/Access to FoodCONNECTION TO NATURAL ENVIRONMENT• Healing Gardens and Natural Light
  • 28. © Planetree 2013Innovations in the Healing Environment:A Patient-Centered Quiet Campaign
  • 29. More EvidenceThe use of call lights by patients decreased by 40%following implementation of decentralized nursingstations & 24-hour visitation (Charmel, 2003)
  • 30. 3. Make datameaningful tostaff.But remember, the dataare not the point,patient experiences arethe point!-
  • 31. © Planetree 2013Making Data Meaningful to StaffEngage staff (and patients) in the selection ofquality measuresInvolve staff in performance improvement efforts Give staff time to participate in improvement effortsDisplay data so it is easy to read and standardizedMake staff aware of the data being measured Discuss in staff meetings Reinforce with postings and displaysMeredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.
  • 32. © Planetree 20134. Look beyond the hospital setting
  • 33. © Planetree 2013New HCAHPS Domain: Care TransitionsMandatory for patients discharged as of Jan. 2013:• Question 1: The hospital staff took my preferences and thoseof my family or caregiver into account in deciding what myhealthcare needs would be when I left the hospital.• Question 2: When I left the hospital, I had a goodunderstanding of the things I was responsible for in managingmy health.• Question 3: When I left the hospital, I clearly understood thepurpose for taking each of my medications.
  • 34. © Planetree 2013Patient-Centered Care TransitionsHospitalSkilledFacilityHome HealthAgencyPhysicianOfficePatient• Same Page Transitions• Inter-Continuum Collaboratives• Physician appointments madeprior to hospital discharge• Discharge summary provided topatient and PCP• Personal Health Records• Support for family caregivers
  • 35. © Planetree 20135. Put compassion first.“I felt like I wasinterrupting themwhen I asked aquestion.”
  • 36. Compassion in ActionVA New Jersey Sleep MenuGood SamaritanHospital PatientStory BoardPhysiciancommunicationcoachingPatient Experience training and education forstaff- Middle Management Training
  • 37. “[The doctor]came in, pulledup a chair andsaid he wantedto talk…and wetalked on myterms.”
  • 38. © Planetree 2013Criteria can be downloaded atwww.planetree.orgA Measureable Framework for PCC CultureChange and HCAHPS Improvement
  • 39. Planetree Designated Hospitals and HCAHPS performance:A marker of Quality:Planetree DesignatedHospitals consistentlyoutperform the NationalAverage on HCAHPS sincepublic reporting of scoresbegan.
  • 40. 6970717273747576Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodPatients Room and Bathroom Always Kept CleanDesignated Hospital Average National Average
  • 41. 62636465666768Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodResponsivenessDesignated Hospital Average National Average
  • 42. Note: The difference is statistically significant (p<0.05).808182838485868788Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodPatients Given Information About Recovery At HomeDesignated Hospital Average National Average
  • 43. 5657585960616263646566Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodStaff Always Explained About MedicinesDesignated Hospital Average National Average
  • 44. 7576777879808182838485Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodDoctors Always Communicated WellDesignated Hospital Average National Average
  • 45. Note: The difference is statistically significant (p<0.05).74757677787980Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodNurses Always Communicated WellDesignated Hospital Average National Average
  • 46. Note: The difference is statistically significant (p<0.05).686970717273Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodPain Was Always Well ControlledDesignated Hospital Average National Average
  • 47. 5556575859606162Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodPatients Room Always Kept Quiet At NightDesignated Hospital Average National Average
  • 48. Note: The difference is statistically significant (p<0.05).60616263646566676869707172737475767778Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodPercent of Patients Highly Satisfied(Overall Rating 9 or 10)Designated Hospital Average National Average
  • 49. Note: The difference is statistically significant (p<0.05).6667686970717273747576777879808182Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12CMS Reporting PeriodWould Definitely Recommend Hospital to Friends and FamilyDesignated Hospital Average National Average
  • 50. The Bottom Line on VBP and DesignationA preliminary analysis indicates that, as a group, Patient-Centered Designated Hospitals are poised to receive:•127%in reimbursement revenue•$770,000(100% of all withheld monies plus additional revenues)
  • 51. © Planetree 2012© Planetree 2012Resources For Your JourneyPatient-Centered CareImprovement GuidePatient-CenteredHospital DesignationCriteriaHCAHPS Assessments
  • 52. © Planetree 2012© Planetree 2012Planetree130 Division StreetDerby, CT 06418www.planetree.org203.732.1365Michael Lepore, PhDDirector of Quality, Research, &Evaluationmlepore@planetree.orgQuestions