Read the tea leaves: Start collecting IV outcomes data now
Read the tea leaves: Start collecting IV outcomes data now
Here’s everything you need to get started today
There’s been plenty of talk about the importance of collecting outcomes data. But if you’re like most home infusion agencies, you’ve yet to get around to it. Here’s a word from the wise you’d better start soon.
You’ve heard the footsteps, and they’re getting louder each day. Look over one shoulder, and there’s the final version of the Health Plan Employer Data and Information Set 3.0 (HEDIS 3.0), a set of 71 standardized performance measures that includes a standardized member satisfaction survey. Beginning in January, the Health Care Financing Administration (HCFA) has required all managed care organizations (MCOs) serving Medicare populations to begin submitting data on HEDIS measures relevant to Medicare. How long until MCOs begin requesting information from care providers?
"Do you want to be ahead of the pack, or do you want to play catch-up?" asks Rose Bemis-Heys, vice president of information management and outcomes analysis for Matria Health Partners in Santa Ana, CA. "I want to know what my customer, the health plan, wants so I can be ahead of the pack. It’s too late if you wait until they ask."
HEDIS 3.0 isn’t all that’s bearing down on home care providers, though. Glance over your other shoulder, and there is the National Committee for Quality Assurance (NCQA) in Washington, DC. Its 1997 standards for health plan accreditation, scheduled to become effective April 1, 1997, include requirements that health plans carefully credential subcontractors, such as home care providers, and carefully monitor the quality of their services.
There’s more. If you’re Medicare-certified, you may find yourself being required to collect such data to maintain your eligibility for participation.
"The word about town is that Medicare will be revising the Conditions of Participation to include a quality improvement type process," notes Nancy Harvey, RN, an independent home health consultant in Acworth, GA. "We can only guess until they’re printed, but it could require agencies to collect data and then implement improvement processes."
But even if you’re not Medicare certified, outcomes data collection still will be critical to your long-term success.
"The impact of having a good measurement process is as significant as a marketing tool with managed care contracts," says Harvey, noting that managed care organizations often look at how you measure your quality and effectiveness when awarding or renewing contracts.
In addition, such data allow you to meet Joint Commission standards.
"It’s a way to communicate with providers you contract with that are JCAHO accredited," says Harvey. "A JCAHO-accredited organization needs to show how they are monitoring the contractual services that are being provided through their agency."
The bottom line regarding outcomes data collection is simple. If you’re not collecting such data already, you’re likely to be left behind by the home infusion agencies that are.
"Many agencies can’t tell you how much their care costs, much less if the patient was satisfied," says Bemis-Heys. "But the time has come: Information will be the lead item to use to go in and sell the agency. Not your nurses’ credentials. Not your protocols. They’re going to look at [information] first."
Getting started
Collecting data sounds simple enough. After all, how hard can it really be to record the final outcome of a catheter placed by your agency? The fact is, it can be very cumbersome, in large part due to the leg work involved.
"In the real world, it is real difficult to get that information back," says Leslie Baranowski, RN, CRNI, program manager for Sutter Central Area Infusion Therapy Service, in Roseville, CA. She finds the biggest hurdle in collecting the information is the amount of follow-up work required every time a patient moves from the home setting to some other care setting, such as a hospital.
But home infusion agencies aren’t the only ones who find it difficult to track such data. Hospitals who send patients home for their infusion therapy are experiencing similar difficulties.
"We get 60% of the forms returned with no hassle," says Judy Scofield, RN, CRNI, the nurse manager of IV therapy services at Virginia Beach (VA) General Hospital. "The other 40%, we have to write a letter or call."
"It’s not hard if you make the effort," adds Deborah Hodges, RN, MN, an oncology nurse specialist and head of the PICC line team at Evergreen Hospital Medical Center, in Kirkland, WA. It started its PICC line program in July 1996 and has collected outcomes data ever since. "The hard part is that it takes time. There are places the system will break down because it’s not a continuous flow of information. You are working between a number of different independent organizations."
One tip Hodges recommends to any provider starting to collect data is to live by the Golden Rule. She is diligent about sharing information when a home infusion agency requests outcomes data. She finds it does more than open the lines of communication.
"We’re rigorous about giving them information on their lines, so they know how important that information is to us," she says.
Documentation is critical
Sutter Central uses a standard form to collect data on every catheter it inserts. It then faxes the form to the facility the patient is being transferred to. At the bottom of the fax is a request that the form be completed and faxed back upon the completion of the infusion therapy.
"This allows us to maintain some kind of record on the device," notes Baranowski. The form is simple to complete. All the health care worker must do is note when the catheter was removed and whether it was removed at the completion of therapy or because of a complication. The sheet lists various complications and, if a complication is the reason for the catheter’s removal, the health care worker is asked to circle which complication among those listed is applicable. Sutter Central completes the remainder of the information, such as when the catheter was inserted.
Virginia Beach maintains a data base of agencies to which it regularly refers patients. Each time a patient is transferred to one of these agencies, Scofield simply faxes a cover letter that gives the patient name and requests the accompanying chart be completed when the PICC is discontinued. (See chart, p. 32.)
If an agency is not in its database, Scofield sends a letter to the agency and follows up with a phone call to explain the data collection’s purpose and process.
"I let that person know why we need the data and that I will be faxing her a form and to call me if she had any questions; then we would talk about it over the phone if she had any," says Scofield.
Touch base’ with follow-up calls
When its outcomes data collection program began, Scofield sent a letter and made follow-up phone calls to each agency her hospital dealt with to explain its data collection. She adds that she still calls the agencies in the database every six to eight months just to touch base and keep on top of any turnover that may have occurred.
Hodges finds it easier to do most of the work over the phone. Although labor intensive, she says it’s quicker than exchanging faxes and letters. However, it’s important to note that each patient is likely to require more than one phone call.
"If you call and the PICC line is still in, you have to follow up again until the line is out, whether it’s out because it was no longer needed or out because there were complications," says Hodges.
Hodges’ system is very informal and being modified as time progresses. Currently, the agency has a pair of forms it developed for its own in-house use to collect the data. (See charts, pp. 33 and 34.)
The PICC line and mid-clavicular documentation tool includes a physician order section, along with a documentation section for the individual placing the line. Information such as the date, reason for the catheter, and tip location is collected. On the back is the complication section, which frequently requires follow up to complete for those patients no longer in the hospital’s care.
The hospital maintains a log book that contains patient and PICC-line information, in addition to a follow-up section on the back of the form. The data needed to complete the follow-up section note if there were any complications. If not completed, Hodges usually will make follow-up phone calls, waiting anywhere from one to three weeks after the previous call, depending on each patient’s situation.
How they’re using the data
Sutter Central uses its data several ways, including its quarterly quality report that monitors the agency’s PICC-related complications. But it also helps track individual staff complication rates.
"The data is entered into a computer database," says Baranowski. "So I can use the information to track staff performance. For each nurse, I can see what lines they placed and what the complications were."
Virginia Beach uses the data to monitor several different aspects of its PICCs.
"We use this information for phlebitis rates, if we need to change the type of catheter or our insertion technique," says Scofield. "We look at whether or not the patient had mechanical phlebitis, then we look at the drug and why we chose a PICC. We also use this on our mid-lines, and it may help us choose a PICC over a mid-line."
Because its program is so new, Evergreen is in the planning stages regarding how it will use such information. Its specific intents include the following:
• Compare surgically placed central lines and PICC lines.
"I want to see the PICC line ratio go up and the surgically placed go down to illustrate we’re reducing costs without reducing care," says Hodges. Specific areas being evaluated could vary from agency to agency, but the bottom line remains the collection of consistent, concrete data to monitor where you are reducing costs most effectively.
• Monitor patient outcomes.
"We’re tracking the information month by month to see if there is a change in the outcome of patients or different kinds of complications," she says. "If we suddenly start to see phlebitis or clotted lines, we can look at what’s happening in terms of the management of lines within the organization or outside that’s causing this."
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