Improving Patient Outcomes
through Quality Transitions
 Founded in 1892, Union Hospital began as a 20 bed
facility and has grown into a 380 bed not-for-profit
hospital
 Union Hospital is a Regional Referral Center serving
patients in west-central Indiana and east-central
Illinois
 The Union Health System also includes Union
Hospital Clinton and several facilities dedicated to
specific service offerings, patient groups, and
physician groups
 Union Health Systems is the largest provider of health
care services between Indianapolis, IN and St. Louis,
MO, providing quality care to all, regardless of ability
to pay.
 Pam Alexander
 Amy McHenry
 Lennie Blythe
 Annette Smith
 Dr. John Bolinger
 Jana Smith
 Myrna Dienhart
 Shad Goodman
 Terri Hill
 Lori Horrall
 Sherri Kannmacher
 Rhonda Smith
 Andrea Spendal
 Jeanette Spradlin
 Stacy Street
 Debbie Stuck
 Kristi Williams
 Dawn Jolliff
 Kerry Wilson
 Dr. Steven McDonald
 Marina Wolfe
Readmission Numbers Above National Average
All Cause Medicare
Readmission Rates to
Union Hospital
 2011 18.9%
 2012 19.2%
Medicare CHF
Readmission Rates to
Union Hospital
 2011 24.8%
 2012 25.8%
*CHF Readmissions Identified as First Priority*
Pilot began October 1, 2012
 A Registered Nurse used in “Coaching” Role
 Identification of CHF Patient on Admit and
Initiation of CHF Education Began
 Teach Back Method of Education was
Utilized
 Assist with Discharge Planning
 Coordination with Next Level of Care
 More Timely Follow-up with PCP
 Increase Communication with PCP Office
 Developed as Monthly Meeting
 Coordination and Communication
 Includes:
• Long term care facilities
• Home health Care
• Hospices
• Area Agencies
• Durable medical equipment companies
 Purpose
 Enhance quality of care
 Define gaps in care
 Improve communication and coordination to next level
of care
 Universal Heart Failure Color Zone
 Soarian Report Built to Identify CHF Patients
 Heart Failure Education Packet Developed
 30 Day Readmission Report Built
 CHF Calendar Revised to Include Monthly Tips
 SBAR Tool Education
 Collaboration with Area 7 Counsel for Aging
 Increased Referrals to Support Agencies
Root Cause
Identification of Patient Diagnosis was
Inadequate
• December, 2012, 37 of 54 CHF Patients Were
Identified During Admission
Identified Problems
1) Computer Systems Do Not Interface
2) Data Fields Free Text Rather than Discrete
Fields
3) Duplication of Efforts Identifying Patients
1) Consistent Process to Identify Primary
Diagnosis Upon Admission
 Quality of Care Improvement
 Appropriate Patient Education
 Effective Discharge Planning
2) Establish Method Where ALL
Departments Use Same Process
3) Aid in the Process of Concurrent Chart
Review for CMS Measures
Streamlined and Standardized
the Report Generation Process
• All Disciplines Receive Same
Report from the Same Source
 Delayed End of Life
Discussions
 Teaching Versus
Motivational
Interviewing
 Physician Buy-In
 Culture
 Difficulty in Diagnosis
Recognition
Building Good Community
Relationships (Partnership with Area 7)
Value of Coordinated Care
Ensuring Timely Inpatient
Intervention as Well as Post Hospital
Follow-up
Need for Open/Honest End of Life
Discussion
 Formation of Palliative Care Team
 Community Support Group for CHF
Patients and Caregivers
 Continued Community Care Transitions
-Work on Gaps in Care Integration with ACO Care Management
 Collaboration with ER Case Management
 Incorporation of Physician Advisor
UNION HOSPITAL
CHF Readmission Rates
40%
35%
All CHF
Pilot Program
30%
*National Average CHF
Readmit -2009
25%
20%
15%
10%
5%
0%
Oct
Nov
Dec
Jan 2013
Feb
Mar
Apr
May
Medicare 30 day Readmissions
All Diagnosis/All Cause
19.5%
19.2%
19.0%
18.9%
18.5%
18.0%
17.5%
16.9%
17.0%
16.5%
16.0%
15.5%
FY 2011
FY 2012
FY 2013
Medicare 30 Day Readmissions
AMI
19.0%
18.4%
18.5%
18.2%
18.0%
17.5%
17.0%
16.5%
16.0%
15.8%
15.5%
15.0%
14.5%
14.0%
FY 2011
FY 2012
FY 2013
Medicare 30 Day Readmissions
CHF FY 2013
45.0%
40.0%
38.5%
36.6%
35.0%
32.5%
30.0%
25.6%
25.0%
23.5%
20.0%
19.4%
20.0%
15.0%
18.8%
13.3%
10.0%
5.0%
0.0%
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Medicare 30 Day Readmissions
COPD
30.0%
26.1%
26.0%
25.0%
19.4%
20.0%
15.0%
10.0%
5.0%
0.0%
FY 2011
FY 2012
FY 2013
Medicare 30 Day Readmissions
Pneumonia
22.0%
21.8%
21.5%
21.0%
20.6%
20.5%
19.9%
20.0%
19.5%
19.0%
FY 2011
FY 2012
FY 2013
o Raised Awareness
• Hospital Staff
• Physicians
• Community
o Increased Communication
• Hospital Staff
• Physicians
• Community
o Coordination
• Hospital Staff
• Physicians
• Community