Agency philosophy says outcomes measurements vital to clinical success
Agency philosophy says outcomes measurements vital to clinical success
Tie outcomes studies to cost savings
It’s not easy being a home care quality manager these days. Staff time and cost pressures have created an environment in which there’s little time or enthusiasm for outcomes measurements and quality studies that are mandated.
Still, quality managers can do this type of research. It only has to be tied to actual work, says Deeley Close Middleton, RN, MS, senior director at Johns Hopkins Pediatrics at Home in Baltimore. The agency provides skilled services for pediatrics in central Maryland and durable medical equipment and infusion therapy for the state.
"Incorporate outcomes measurements in your pathway and make it automatic," she advises. "You have to make it inherent in the process, whether it’s a clinical program or disease pathway that you’ve written."
For instance, if an agency has a disease pathway that establishes a process a patient should follow on each visit, then outcomes measurements can easily be tied to that pathway. The first step is to define what you’re measuring, with what frequency you’ll measure it, and how the data will be sorted and stored. For example, Johns Hopkins Pediatrics at Home tracks outcomes related to rehospitalization of the agency’s new natal IV population. This directly relates to the agency’s quality of care.
"You need to measure whether your action effected any change within the program you put together," Middleton says. "Are you achieving what you are supposed to be doing?"
Middleton suggests quality managers make the most of their outcomes studies by incorporating these processes:
• Catch trends early. The pediatric agency tracks asthma patient outcomes. It tracks hospital days, following those around the asthma pathway. It records data about how many times patients return to the emergency department. If a trend appeared that patients have preventable emergency department visits, then the agency will go back and examine the pathway, perhaps making changes to improve the outcome, Middleton says.
Assess and improve
The asthma outcomes measurement also looks at the number of hospital days and readmissions. By tracking this data, the agency satisfies two goals: First, quality managers will know very quickly whether there are any problems with the asthma management program. Any unexplained spike in rehospitalizations or emergency department visits will result in an investigation. Second, the agency can present its positive outcomes to payers and others as proof that the asthma management program works.
• Look for the root cause. Quality managers need to find out why a particular trend is occurring. They need to make sure the outcomes measurements relate to the root cause of what the agency is trying to accomplish.
"Make sure what you’re using to measure the outcomes trend is a true correlation," Middleton says. "If you’re looking to change asthma behavior and supposing a child has 40 emergency department admissions, the analysis should show the true cause of the child’s having a positive change in these admissions."
For example, the agency decided to provide an analysis of emergency department admissions of asthma patients because those are the biggest health care costs those patients face, particularly now that hospitalizations have been reduced due to managed care pressures.
Therefore, a good indicator that asthma patients are having trouble managing their disease would be an increase in emergency department visits. The root cause of poor asthma management could be measured indirectly through monitoring those visits.
• Keep data aggregation clean. The staff hired to aggregate the data may change, but this should not result in sloppy data compilation. That’s why it is important for agencies to have specific data aggregation processes in place, so that everyone who does this task will do so the same way.
"It should be a part of the clinical program, and it should be inherent in any company’s clinical operations," Middleton says. "This is part of the performance improvement mission, so it’s inherent and continuous."
Form partnership to collect data
One inexpensive way to collect and keep the best data is to form a partnership with another party. For example, Middleton’s agency formed a partnership with Johns Hopkins Healthcare (JHH), which is a third-party administrator. JHH keeps records and collects data on all of the people it covers so the home care agency can develop outcomes projects with JHH that use those data. The projects can tie clinical data to financial data, Middleton says.
"If companies can partner with payers, you will really get some great results," she says.
• Prepare presentation material. Johns Hopkins Pediatrics at Home uses its quality projects in presentations to the agency’s advisory committee board on a quarterly basis.
This gives board members a timely look at how the agency is doing with regards to its clinical outcomes before and after a new pathway has been implemented.
The agency also presents results to referring physicians, specialists, and case managers to show them the progress in patient care.
"That’s also a way to use it as a marketing tool if you have good results," Middleton says.
Each quarter, the presentation focuses on a different outcomes project. One time it might be asthma management and the next time it could be neonatal care.
Also, board members, physicians, and others who hear those presentations are asked for their feedback on the processes. Then, their suggestions can be incorporated into pathways and care plans.
• Deeley Close Middleton, RN, MS, Senior Director, Johns Hopkins Pediatrics at Home, 2400 Broening Highway, Baltimore, MD 21224. Telephone: (410) 288-2268. Fax: (410) 282-8449. E-mail: middleton-deeley @jhmi.edu.
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