July 2008 e-Bulletin

Welcome to the Home Health QIOSC monthly e-Bulletin, your source for the latest updates in home health quality improvement. You may either browse the newsletter or use the icons at the top of the page to jump to a specific section.

Post Date	Educational Resource	Content Description	Location
6/15/08	Depression (for Clinician) ZONE Tool*	This tool will assist clinicians with assessment and intervention strategies.	Behavioral Health
6/15/08	Health Literacy - What Is It and What Can We Do About It?*	This WebEx describes what health literacy is and suggests interventions for health literacy concerns. The presenter is Paul D. Smith, MD, Associate Professor, University of Wisconsin Department of Family Medicine	Quality Improvement
6/15/08	Polish Your Practice - Data Analysis*	The Polish Your Practice - Data Analysis Series will give quality improvement specialists the knowledge to assist with accessing, interpreting and utilizing data to improve quality outcome measures.	Quality Improvement
6/26/08	Pain Management ZONE Tool*	This tool will assist patients/caregivers with managing pain and using red, yellow and green zones. It will also assist in determining when to call the physician or when to go the emergency department.	Pain Interfering with Activity
6/26/08	Polish Your Practice - Diabetes Series*	The Polish Your Practice - Diabetes Series will assist clinicians in learning the current guidelines and practices for helping patients with diabetes. A three-part WebEx by Irene Cole, MSN, CDE, is included, as well as a WebEx on pharmacologic interventions by Anna Wodlinger Jackson, Pharm D, BCPS.	Disease Management
6/26/08	Asthma ZONE Tool*	This tool will assist patients/caregivers in managing asthma using red, yellow and green zones. The tool will also assist in determining when to call the physician and/or go to the emergency department.	ACH
6/26/08	CHF ZONE Tool*	This is a tool designed to help patients manage congestive heart failure.	ACH
6/26/08	COPD ZONE Tool*	This tool was designed to help patients manage Chronic Obstructive Pulmonary Disease.	ACH
6/26/08	Diabetes ZONE Tool*	This tool will assist patients and caregivers in managing diabetes with red, yellow and green zones. It will also assist with determining to call the physician and/or go to the emergency department.	ACH
6/26/08	Foley Catheter ZONE Tool*	This tool assists patients and their caregivers to figure out who and when to call for help.	Urinary Incontinence
7/3/08	Polish Your Practice Series Toolbox	The Polish Your Practice Toolbox contains links to helpful WebExes and tools on the following topics: heart failure, wound management, diabetes, data analysis, health literacy, Medicare Advantage Plans, Chronic Care Model, Ready Aim Improve, best practices for reducing ACH, clinical record review forms, ZONE tools, and OASIS.	ACH

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The Home Health Quality Improvement (HHQI) National Campaign Best Practice Intervention Packages (BPIPs) can be accessed at www.medqic.org.

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There are no pending deliverable dates at this time.

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National HH QIO Call:  Tuesday, July 22, 2008, 3:00 p.m. (ET)
1.866.861.5389; ID: 898993

The June CoP and HH National Calls were recorded and may be reviewed on Quality Insights of Pennsylvania's Web site.

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Some Final Thoughts from the Home Health Quality Improvement Organization Support Center (HH QIOSC)

Successes from 8^th SOW Quality Improvement Organization—Home Health Task and the Home Health Quality Improvement (HHQI) National Campaign:

• Strides in reducing ACH and improving other publicly reported outcomes (as evidenced by data)
• Implementation of best practices across the country like hospitalization risk assessment, SBAR, frontloading visits, phone monitoring - these and more are now common language at many home health agencies
• Increased awareness from national and state associations, state and national conferences, peer review and trade publications of reducing ACH
• Provided home health agencies the future pathway for health care - patient self-management, chronic disease management and transitional care coordination

The successes listed above (and there are many more) demonstrate the commitment and determination to improve the quality of patient care with home care providers. This was accomplished because of YOU - the home health leaders and coordinators of the QIOs. The Home Health QIOSC team would like to thank each and every one of you for your commitment to this work. It has been our pleasure to work with you, and we thank you for your support and encouragement. The last three years were a whirlwind of activity, and it was a wonderful opportunity to develop professional and collegial relationships!

Eve Esslinger, RN, BSN, MS

Interim Director HH QIOSC
Quality Insights of Pennsylvania

Baptist Home Health Network
Baptist Home Health Network is a health system-based non-profit home health and hospice agency in Little Rock, Arkansas. It has an average daily census of about 780 patients. Paula Suter, RN, MA, is the Director for Chronic Care Management, and she shares how staff have utilized the Patient Self-Management Best Practice Intervention Package (BPIP) when they designed a new patient care delivery model called the “Home-based Chronic Care Model.”

Due to a census that includes ever increasing numbers of patients with chronic diseases, Baptist Home Health Network’s (BHHN) staff made a strategic decision to ensure they were experienced in the provision of chronic care and self-management support. In an all but certain pay for performance future environment, and with a desire to improve the lives of the patients they serve, BHHN leaders conducted a thorough analysis of agency strengths and weaknesses with regard to the ability to strongly support all aspects of the patient disease self-management process. 

BHHN utilized the Self-Management Support Agency Assessment provided as part of this BPIP. The use of this tool enabled a targeted approach, resulting in the identification of key areas needing attention. For example, clinical nurse specialists obtained the Disease Management Association of America’s Chronic Care Certification; identified core self-management competencies needed by all staff for high quality self management support; and designed an eight-session chronic care certification course of their own, with a home health care orientation. The BPIP assessment tool guided agency plans for the evaluation of care based on the new delivery model, with a clear identification of desired outcomes and methods for measurement. As another example of actions taken, BHHN leaders saw the need for a more comprehensive depression screening tool for use with this population at the start of care. A reliable, validated tool was selected then incorporated into the point of care EMR software. Clinician use of the tool, as a standard of care, is currently being measured as one criterion for clinician certification as a chronic care specialist within the agency. There have been many new self-management assessments and interventions assimilated in the agency’s provision of chronic care, which were spring-boarded by the BPIP agency assessment tool. This thorough assessment was a critical step for securing leadership support toward achieving an organization-wide commitment to this best practice.

We would like to thank Paula Suter, RN, MA, Director, Chronic Care Management and her staff at Baptist Home Health Network/Healthy Solutions in Little Rock, Arkansas for sharing their ‘building upon the basics’ approach to care delivery.

Tips of the Week

View the June 2008 Tips of the Week.
View the May 2008 Tips of the Week.
View the April 2008 Tips of the Week.
View the March 2008 Tips of the Week.
View the February 2008 Tips of the Week.

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