PhoneMonitoringIPROImprovingHealthcareforthe…電話監(jiān)控IPRO改善醫(yī)療保健…醫(yī)學(xué)課件

1、Home Health Quality Improvement (HHQI) National CampaignPhone Monitoring & Frontloading Visits Vicky Agramonte, RN, MSN June 13, 20191第1頁，共50頁。New York State Local Area Network of Excellence (LANE)2第2頁，共50頁。Objectives Provide an overview of Phone Monitoring and Frontloading Visits intervention packa

2、ge materialDemonstrate the value of structured clinical interventions of phone monitoring and frontloading visitsIdentify how phone monitoring and frontloading visits can be implemented and/or used effectivelyProvide an overview of tools that support these strategies3第3頁，共50頁。Simply Summer Series 4第

3、4頁，共50頁。Why combine these strategies?Natural relationship between the strategies Proven to reduce your ACH rateEffective strategy that can be incorporated into the risk assessment 5第5頁，共50頁。6第6頁，共50頁。Promoting Patient Self ManagementIntensive teaching and coaching during the first weeks of care Star

4、ts with informing the patient/caregiver of their high risk status at SOCEmergent Care PlanningDisease Management Self Monitoring and reporting of symptomatologyFollow-up to provider appointments 7第7頁，共50頁。Frontloading Visits 8第8頁，共50頁。Frontloading Visits DefinedProviding more visits early in the epi

5、sode with the expectation that more frequent visits will not only increase symptom surveillance but also promote more intensive patient teaching 9第9頁，共50頁。Frontloading Visits Consider structuring protocol to provide the majority of planned visits, by all disciplines, in the first three weeks of care

6、Does not mean MORE visits Improved service utilization by all disciplinesSchedule visits sooner or postpone visits based on problems or progress reported Should see a decrease in length of stay10第10頁，共50頁。ACH Rates Home Health Length of Stay % Episodes ending in ACH Within 1 week of SOC 25.44%Within

7、 2 weeks of SOC44.65%Within 3 weeks of SOC57.83%Source: CY2019 OASIS Data 11第11頁，共50頁。Effective FrontloadingRequires: Continuity of care from staff who provides care from any discipline Intense care coordination of servicesInterdisciplinary teamwork that includes the home health aide 12第12頁，共50頁。Wha

8、t Population Should be Considered for Frontloading?Patients who are assessed as high risk and/or high level of acuity at SOC/ROCDisease specific populationsCHF COPD Diabetes HIV/AIDS 13第13頁，共50頁。Frontloading StructureExamine current agency policy: Consider minimum number of weekly contacts for 2-3 w

9、eeks Develop protocol that builds a structure for visit frequency and case conferencing14第14頁，共50頁。Benefits of Frontloading Visits Provides opportunity for validating initial assessments, including risk assessmentProvides opportunity for ongoing educationSupports improved service utilization Improve

10、d patient satisfactionUse as a marketing tool 15第15頁，共50頁。Phone Monitoring 16第16頁，共50頁。Phone Monitoring Defined Scheduled, remote care delivery or monitoring in which scheduled patient encounters via the telephone occur between a health care provider and patient or caregiver17第17頁，共50頁。What populati

11、on should be considered for phone monitoring?Patients who are assessed as high risk Patients with a history of non-adherencePatients who exhibit a high degree of anxiety related to their careDisease specific populationsPatients who do not meet inclusion criteria for telehealthOverflow of patients fr

12、om telehealth Patients that are monitored using telehealth18第18頁，共50頁。Benefits of Phone Monitoring Frequent communication with high risk patients Increase patient/caregiver trust in agency responseReinforce emergency care planning with each encounter Opportunity to intervene when early signs of decl

13、ine are identifiedManage resources effectively Supplement visits with phone monitoring Marketing tool to referral sources19第19頁，共50頁。Patient Selection Criteria Patient has the ability to access and communicate by phonePatient willing to accept phone monitoring as a clinical interventionInform patien

14、t and family that they are a candidate for phone contacts and obtain permission and buy in Patient has the ability to self monitor 20第20頁，共50頁。Leadership ConsiderationsImplementing phone monitoring will impact other areas of practice:Scheduling: May consider adjusting clinician productivityIf self s

15、cheduling insure clinician puts phone monitoring on scheduleIf there is a scheduler insure they understand the importance of phone monitoring being part of the clinicians daily schedule21第21頁，共50頁。Leadership Considerations Documentation guidelines Structure to phone monitoring by using “scripts” to

16、establish continuity of task Determine the need for physician ordersInsure patient confidentiality of phone monitoring 22第22頁，共50頁。Who Should Conduct Phone Monitoring Encounters?Can be an in-house staff memberFacilitatorTeam leaderSupervisors Intake staff Hospital or discharge liaison Telehealth nur

17、se Triage unit Medical social workersOther clinical disciplines Volunteers Or23第23頁，共50頁。 Protocol Template 24第24頁，共50頁。Benefit of Phone Monitoring and Frontloading of Services Use as an intervention based on patient risk factorsSupplement visits with structured phone calls Reduced length of stay In

18、creased patient satisfaction 25第25頁，共50頁。Benefit of Phone Monitoring and Frontloading of ServicesImprove or strengthen your agencys survey results by: Improving care coordination Support clinicians by structuring the first 2 3 weeks of careProvide clinical guidance for the visitConsistent documentat

19、ion and interventions for high risk patients 26第26頁，共50頁。Implementation Use of HHQI Campaign Reports: Review HHQI data reports and assess if the “hospitalization by day of the week” may offer suggestions for planning phone monitoring or frontloading visits27第27頁，共50頁。MSW and HHA Tracks Medical Socia

20、l Worker Focus on interventions within realm of social workerAssist with financial, cognitive, non-adherence concerns that exacerbate anxiety Home Health AideOrient home health aide to the focus of the team and their vital role in providing a skilled service Instruct aide on what issues need to be r

21、eported to clinicians (physical, environmental, financial)28第28頁，共50頁。Therapy Track Designed to promote coordinate with other disciplines Defines the role of the therapist during the first weeks of careCampaign now offers “certificate of attendance” that may be accepted by state or national associat

22、ion 29第29頁，共50頁。Managed Care Connection 30第30頁，共50頁。Hospital Connection 31第31頁，共50頁。Nursing Post-Test Questions 32第32頁，共50頁。HHQI Intervention Tools 33第33頁，共50頁。34第34頁，共50頁。35第35頁，共50頁。36第36頁，共50頁。37第37頁，共50頁。38第38頁，共50頁。39第39頁，共50頁。40第40頁，共50頁。Scenarios With and Without Frontloading and Phone Monito

23、ring41第41頁，共50頁。Frontloading/Phone Monitoring 42第42頁，共50頁。No Frontloading/Phone Monitoring43第43頁，共50頁。Web links, Resources and References Joann Rogers presentation, audio link, and phone assessment documentation: /dcs/ContentServer?cid=1142280316372&pagename=Medqic%2FMQPresentations%2FPres

24、entationTemplate&c=MQPresentationsNew York Heart Association CHF Classification: /presenter.jhtml?identifier=4569 Home Telehealth Reference 2019:/dcs/ContentServer?cid=1122297924530&pagename=Medqic%2FMQTools%2FToolTemplate&parentName=RecommendedAction&c=MQTools National Gu

25、ideline Clearinghouse management of CHF: /summary/summary.aspx?doc_id=5184&nbr=003566&string=CHF#top 44第44頁，共50頁。Next Steps Leadership determines the need to add this strategyDevelop policy and protocols Choose a patient population Pilot on small group of clinicians Analyze results, mod

26、ify and spread to a larger group 45第45頁，共50頁。Measurement of Success Consider use of “Telehealth Data Collection Tool”O(jiān)btain quantifiable data to prove the success of the strategy Add strategy to Best Practice Monitoring Tool Audit for staff compliance 46第46頁，共50頁。Schedule for Intervention PackagesMo

27、nthBest Practice TopicMarch 2019Hospitalization Risk AssessmentApril 2019Patient Emergency PlanMay 2019Medication ManagementJune 2019Phone Monitoring and Front-Loading VisitsJuly 2019TeletriageAugust 2019TelemonitoringSeptember 2019ImmunizationOctober 2019Physician RelationshipsNovember 2019Fall Pre

28、ventionDecember 2019Patient Self-ManagementJanuary 2019Disease ManagementFebruary 2019Traditional Care Coordination47第47頁，共50頁。IPRO Contact InformationSara Butterfield Project Leader IPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext. 104Fax: 518-426-3418sbutterfieldnyqio.

29、 Victoria AgramontePerformance Improvement Coordinator IPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext. 115Fax: 518-426-3418 Christine StegelPerformance Improvement Coordinator IPRO20 Corporate Woods BoulevardAlbany, New York 12211Phone: 518-426-3300 ext