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  • success in breaking down barriers in the short time we have been doing this
    Patient declines – too old, sounds too much like work, already in DM program (Insurer) “I don’t have HF.” or worse “I have HF?!!?”
    Phys opposition: don’t see value, fear of taking patients away from them, fear of confusing patients, concern that patients will view telephony as a substitute to regular physician visits, (what if you tell my patient something I don’t want him to know”
    Rehab – we are an inpatient setting - older and sicker pop in acute care setting - lose 2 weeks of reinforcement
    Nursing home – challenge lies in convincing them that it is a client service they should provide – feel they asses their pts and intervene appropriately
    lack of resources - personnel, scales, time
  • The next big challenge was achieving physician buy-in…
    Physician champ – chief of cardiovascular surgery and cardiologist. With their assistance we presented our vision of HF DM management ………
    Soarian DM demo
    Discussed at section meetings
    Presented a slide show at noon conference (CME)
    Presented our core compliance data and our “quality improvement” plan to our Quality Council
    Newsletters to medical staff
    1:1 – most effective
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  • Community recog – NY and Virginia
    Reduced hosp visits – tracking
    Pt outcomes – to date no one in telephony program has been readmitted for HF – we have strong anecdotal evidence that we have avoided readmissions on 5 occasions for 2 different patients
    Intangibles – better public perception because our reported data looks good – attracts patients; customer satisfaction due to attention and effort expended by DM nurses; promotes continuum of care (inpatient, outpatient, EP); ed makes a difference – better outcomes for pts; reduced LOS if admitted (come is less ill, go home earlier because monitoring is available)
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    We have had success in the management of Congestive Heart Failure by utilizing disease management software. The hospitals are not losing money from patients admitted for CHF…they can utilize the beds for other admissions. Physicians can be utilized in other areas because the nurse is able to monitor CHF patients for the physician and alert them when a patient needs changes in their management. The patients feel they have a better quality of life since enrollment into the program. Patients are scheduled for their tests and procedures due to reminders based on CHF guidelines. In the future we anticipate reimbursement from our insurers for effective disease management services.
  • Presentation Material (Powerpoint)

    1. 1. Chronic Care Taking Disease Management Beyond Hospital Walls Sandra Garrison BSN MBA Director Chronic Heart Failure Initiative The Chester County Hospital Alan Barbell MBA Product Manager, Siemens Medical Solutions
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    3. 3. 3 The Chester County Hospital  Founded in 1892  Independent, not-for-profit  Licensed beds – 221  Number of employees – 1700  Emergency department visits – 41,244  Cancer Center affiliated with HUP  Pediatric and Level III NICU affiliated with CHOP  Interventional Cardiology & Electrophysiology  CV Surgery affiliated with The Cleveland Clinic
    4. 4. 4 Disease Management  A systematic population based approach to identify patients at risk  Utilizes evidence based guidelines to prevent exacerbations and complications of chronic disease  Supports the practitioner/patient relationship and plan of care  Measures clinical and other outcomes to improve quality of care
    5. 5. 5 Disease Management Support  We do not take over management of patients from the PCP – we support the medical plan of care  Collaboration with outpatient managers of care to promote consistency in treatment, educational and intervention strategies  Act as a resource for staff and patients
    6. 6. 6 Why Heart Failure DM? Nationally  Leading cause of hospitalization in persons over age 65 Our Experience  127 – our highest volume DRG  Costs $25.8 billion annually  ALOS 6.2 days  20% - 50% readmission rate within 6 months  20% readmission patient failure to seek medical attention for worsening symptoms  2005 costs - $4,607,923 2005 reim. - $4,252,997 ($354,926)  ALOS 6.4 days  Comparable  Comparable
    7. 7. 7 Heart Failure at CCH  467 discharges last year with a primary diagnosis of HF  75% of our HF patients group to DRG 127  DRG with greatest number of excess days  Through-put issues/bed availability  Core measure compliance
    8. 8. 8 Our Starting Points  Order sets  “Choose and check” progress notes  Discharge forms  Discharge reminders  Patient education material  Medical and nursing staff education
    9. 9. 9 Getting Started Physician Buy-In
    10. 10. 10 Physician Concerns  Patients will be confused  Patients will stop coming for office visits  Patients might be told something I don’t want them to know  Conflicting literature about the efficacy of DM programs
    11. 11. 11 Success with Physician Buy-In  Physician champion(s)  Demonstration  Progress reports  Section meetings  CME conferences  Quality Council  Newsletters  1:1 “hallway conferences”  Luncheon meetings with PCPs  Bi-weekly HF Taskforce Meetings
    12. 12. 12 Skepticism to Collaboration Linking with a Cardiology Practice  Increase patient satisfaction?  Improve/enhance communications between inpatient and outpatient environments?  Promote core measure documentation compliance?  Reduce LOS when patient is admitted?  Reduce admissions, ED visits and unscheduled office visits?  Increase patient accountability?
    13. 13. 13 How We Make It Work  Admission notification  Patient education  Assessment for enrollment in telephone monitoring  Assessment for enrollment in research study  Assess medical record for compliance with core measures  Interdisciplinary collaboration
    14. 14. 14 CCH Admission Notifications 1. Soarian Workflow Alert. A patient with a admission DX suggesting CHF has been admitted. Patient's Name: ******** has been admitted to floor TELE Bed: 331101. The patient's MRN is ******* and their PT ID is 10000*******. The admitting diagnosis is ACUTE DYSPNEA STABLE PNEUMOTHORAX, LEFT PLEURAL FUSION,S/P CORONARY ARTERY BYPASS GRAFT 2. Soarian Workflow Alert. A patient with a history of CHF has been admitted. Patient's Name: ******** has been admitted to floor ACC Bed: OACC21. The patient's MRN is ****** and their PT ID is 10000******. The admitting diagnosis is LEFT TOTAL KNEE ARTHROPLASTY. The last inpatient admission for this patient was on: Unknown
    15. 15. 15 CCH Admission Notifications 3. Soarian Workflow Alert. A patient enrolled in the outpatient CHF program has been admitted. Patient's Name: ********** has been admitted to floor TELE Bed: 330702. The patient's MRN is ******* and their PT ID is 10000*******. The admitting diagnosis is Unknown 4. Soarian Workflow Alert. A patient has just had a new BNP above 150. Patient's Name: ************ is on floor WW2 Bed: 026102. The patient's MRN is ****** and their PT ID is 10000*******. The admitting diagnosis is GROSS HEMATURIA. The reported BNP level was: 416
    16. 16. 16 Soarian DM  Computerized data base of HF patients enrolled in telephone monitoring  Alerts trigger outbound calls  Allows nurse to manage high number of patients and focus outbound calls  Early intervention is facilitated  Promotes continuum of care
    17. 17. 17 Outcomes  Recognition/acceptance within the organization as evidenced by medical and nursing requests for consults  Community and regional recognition  Increased collaboration/communication between inpatient and outpatient healthcare practitioners
    18. 18. 18 Outcomes  Reduced hospital visits  Bed opportunity  Increased awareness of physician practices d/t concurrent chart review  Improved compliance with core measure documentation  Positive patient feedback
    19. 19. 19 Next Steps  Hospital based HF Clinic  Short stay inpatient unit  Con-current coding  Electronic notification based on EF  Apply what we have learned to extend DM support to larger CV patient population  Test Soarian DM 2.1
    20. 20. 20 Soarian Disease Management  Patient self monitoring via Interactive Voice Response  Customizable notifications/reminders  Patient compliance tracking  Problems and interventions checklist  Telephonic nursing assessments
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    31. 31. 31 Potential Impact of Disease Management Programs Reduce Negative Financial Impact of treating chronic ill patients by reducing Admission LOS and ER visits Reduce Negative Financial Impact of treating chronic ill patients by reducing Admission LOS and ER visits Optimize Resources by freeing up valuable resources for higher reimbursable procedures Optimize Resources by freeing up valuable resources for higher reimbursable procedures Revenue Quality EfficiencyImprove Quality of Care by delivering better care to at risk patients Improve Quality of Care by delivering better care to at risk patients Improve Patient Affinity by keeping valuable patients tied to your organization Improve Patient Affinity by keeping valuable patients tied to your organization Prepare for Future Revenue anticipate reimbursement for disease management services (CMS) Prepare for Future Revenue anticipate reimbursement for disease management services (CMS)
    32. 32. 32 Questions?

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