TIP OF THE WEEK
Reduce Avoidable Hospitalizations Using the CASPER Case Mix Profile Report
The ”Case Mix Profile at Start/Resumption of Care” report provides a descriptive overview of your agency’s patients. The report includes information about patient characteristics, circumstances, disabilities, and diseases based on the OASIS items that were assessed by the staff and transmitted. For each case mix item, the larger national reference mean is also displayed and items where your agency significantly differs from the national reference are flagged.
Understanding how your agency compares to national averages could enable you to be more proactive in establishing interventions that will improve the outcome rates for your agency. It is also important to consider the impact certain patient diagnoses or conditions have on outcomes such as acute care hospitalization. The patient’s caregiver or living situation may impact hospital readmission as well.
Begin by looking at the items where your agency is significantly different from the reference mean. Ask yourself; does this item have a clinical impact? Then ask, “what can be done about it?” Pay specific attention to the items listed below, as they have the potential to impact clinical care decisions focusing on acute care hospitalization:
- Lives alone
- Primary caregiver frequency assistance
- Medical Regime change within 14 days
- ADL disabilities: bathing, toileting, transferring, ambulation
- Management of oral meds
- Light meal preparation
- Dyspnea
- IV therapy, parenteral nutrition, enteral nutrition
- Speech language impairment
- Pain interfering with activity
- Intractable pain
- Neuro/Emotional/Behavioral Status: moderate cognitive disability, severe confusion disability, severe anxiety level, behavior problems > twice a week
- Integumentary Status (wounds)
- Elimination Status
- Acute conditions
- Chronic conditions: urinary incontinence/catheter, dependence in medication administration, chronic pain, cognitive/mental/behavioral
- Length of stay: LOS until discharge, LOS from 1 to 31 days
- The agency, due to its unique circumstances, might consider others as appropriate
The agency, due to its unique circumstances, might consider others as appropriate.
Let’s look at an example of how information from the Case Mix report can be used. An agency identified three case mix items that were significantly different than the reference mean: cardiac/peripheral vascular acute conditions, speech/language, and neuro/emotional/behavioral status. In the case of cardiac/peripheral vascular acute conditions the agency’s patient population was significantly higher that the nation reference population. For speech/language and neuro/emotional/behavioral status the agency’s patients were significantly more impaired than the national reference population. Upon investigation it was discovered that the most frequent acute cardiac condition among the agency’s patients is congestive heart failure (CHF). Consider the example agency's other significantly different items as they pertain to the CHF patient:
- Patient education is an important of the care plan. What impact does a diminished speech/language capacity present for patient education?
- Compliance with a medication regime is essential. Can moderate cognitive disability and severe confusion disability impact the patient’s ability to take medications as ordered?
- Is it possible that a severe anxiety level could exacerbate cardiac symptoms?
This information can be used to develop a plan of action that focuses on the clinical care behaviors of a targeted patient population.
FISHBONE DIAGRAMM
Case mix reports focus on what can be found in the clinical record. There are times, however, when the answers lie elsewhere. A more global approach requires looking at the people, equipment/machines, materials/forms/supplies, and methods/standards (policies and procedures) and evaluating the effectiveness and efficiency of these factors. A fishbone analysis can help you take an in-depth look at factors that contribute to the potential causes and that affect the outcome. The following depicts such an analysis for acute care hospitalization.
Any one of these targeted areas and their processes can be studied to help identify where the problem lies (a root cause). From this study, best practices can be identified. Perhaps looking at Care Planning/ Coordination would be a first step. Has the physician established parameters for blood pressure, pulse, respirations, and weight within 24 hours of admission? Does clinical staff notify the physician of aberrancies the same day? Does the clinician explain to the patient/caregiver how to reach the agency after hours with concerns? By the end of the third visit, can the patient/caregiver verbalize signs and symptoms of a worsening condition to report? Or perhaps Assessment is an issue. Does the intake staff initiate the patient high risk-assessment for hospitalization by collecting information on prior hospitalizations and emergency department visits and co-morbid conditions? Does the clinician complete a hospital risk assessment at start of care (SOC)/ resumption of care (ROC). If the patient is identified as high-risk for re-hospitalization are visits front-loaded? Is a phone monitoring scheduled established?
RESOURCE SPOTLIGHT
Quality Improvement Worksheets
Use these worksheets to implement quality improvement techniques such as process analysis, forming a team, fishbone diagram, pilot testing, root cause analysis, and pilot testing.
IN THE NEWS
MAY 7 IS LEGACY FREE DAY
With the support of the Centers for Medicare & Medicaid Services (CMS) and the Healthcare Information and Management Systems Society (HIMSS), clearinghouses that submit fee-for-service Medicare claims will require providers to submit claims using their National Provider Identifier (NPI) information. This exercise is your opportunity to test their NPI number. If your claim is rejected or suspended, you will have until the May 23, 2008 deadline to resolve the issue. | Apply for an NPI
DECISION MEMO FOR SCREENING DNA STOOL TEST FOR COLORECTAL CANCER
April 28, 2008 -- CMS -- CMS announces plan not to expand the colorectal cancer screening benefit to include coverage of the DNA stool test for colorectal cancer. The agency will consider a request for reconsideration when a commercially available stool DNA test has been cleared or approved by the FDA. Read more >>
STUDY SHOWS DEMENTIA RESIDENTS RECEIVE REGULAR PAIN MEDICATION LESS OFTEN THAN COGNITIVE RESIDENTS
April 30, 2008 -- Reuters Health -- Research from the University of North Carolina Chapel Hill indicates that residents who were cognitively impaired may be less likely to receive regular doses of pain medication or to receive pain drugs at all, when compared to a cognitively intact resident group with similar health conditions. The researchers note that this is likely due to pain medications being taken “as needed,” and it is easier for individuals without cognitive impairments to communicate their requests. Read more >>
PENN STUDY FINDS ELDERLY HEART PATIENTS WITH ICD DEVICES LIVE LONGER AFTER HEART FAILURE
April 30, 2008 -- EurekAlert -- A new study out of the University of Pennsylvania indicates that implantable cardioverter-defibrillators (ICDs) may be a cost-neutral solution to help people diagnosed with CHF live longer. Read more >>
OHIO KEPRO EVENTS
OBQI TRAINING
The Outcomes-Based Quality Improvement (OBQI) Process is a systematic, data-driven method of investigating patient health outcomes and developing improvement strategies that are tailored to suit your agency’s unique population.
Join us for a refresher course in your area. We are offering two courses:
- 9:00 to 12:00 -- OBQI Basics
- 1:00 to 4:00 -- Beyond the Basics
| May 15 | Summa Home Health at St. Thomas Hospital, Akron |
| May 20 | Mount Carmel Home Health, Columbus |
| May 22 | St. Rita’s Hospital Home Care Aux. Conference Center, Lima |
| May 28 | Kettering Network Home Health, Miamisburg, Ohio |
| June 4 | Union Hospital Auditorium, Dover |
For more information or to register, go to www.ohiokepro.com/providers/homehealth/events.asp.
COMING ATTRACTIONS
Ohio Home Care Organization – Upcoming Education
- May 12 – Palmetto GBA Updates for Hospice and Home Care
- May 13-14 – Home Health Spring Conference
Ohio Council for Home Care – Upcoming Education
- May 13-15 – Breaking the Code – Competency in Diagnostic Coding
Health Policy Institute of Ohio: Regional Meetings on the Ohio Family Violence Prevention Project
The Tip of the Week Archive is available on the Ohio KePRO Web Site.
Clinically driven. Client focused. Value based.