OASIS Alert

Including 5 that don't cost money.

The most commonly used approach to preventing unplanned hospitalizations is a falls prevention program. Does your agency use any of the other most successful measures?

During the next three years, quality improvement organizations nationwide will work with home health agencies to decrease acute care hospitalizations. More than 100 agencies in 12 states have already participated in a pilot project with their QIOs, and you can learn from their experiences, explained Del-marva Foundation's Karen Pace.

The national average for acute care hospitalization has stayed at about 28 percent for the two years of Home Health Compare, Pace told attendees at the National Association for Home Care & Hospice's October annual meeting in Seattle. Agencies should expect the reasons for the difficulty in improving this outcome to be multidimensional and the solutions will be also, she said.

Lessons learned: Agencies that participated in the pilot project offered these suggestions:
 
• Get staff input and buy-in before you begin.
• Use interdisciplinary teams.
• Start simply and add strategies over time.
• Allot enough time to accomplish the task.
• Do an extensive process of care investigation.
• Request assistance from your QIO.
• Get buy-in from agency leaders.
• Promote patient self-management.
• Collaborate with hospitals on discharge criteria.
• Establish transition protocols with hospitals and skilled nursing facilities.
• Develop disease management practices for high-risk diseases.
• Identify high-risk patients in the first 24 to 48 hours.

How Many Of These Measures Do You Use?

To look for successful strategies that would reduce acute care hospitalization, Northampton, MA-based Fazzi Associates, the National Association for Home Care & Hospice and Briggs Corp. sponsored a study to determine how the agencies with the best outcomes in this measure reduced their rates.

The study identified 15 measures that seemed to have the most impact in reducing hospitalization, Robert Fazzi reported at the NAHC meeting.

Five of these measures do not cost money, Fazzi said. More than 50 percent of the top-performing agencies used the first eight measures, he added.

1. Fall prevention (83 percent of agencies)
2. Front loading services (71%)
3. Management culture and support (69%)
4. Medication management (64%)
5. 24-hour availability/response (63%)
6. Patient/caregiver educations (57%)
7. Case management (56%)
8. Special support services (52%)
9. Disease management program (43%)
10. Data driven services (43%)
11. MD relationships (40%)
12. Safety/risk assessment (38%)
13. Hospital referral relationship (23%)
14. Telehealth (11%)
15. ER relationship (9%) v

Note: The Briggs study report with a description of the 15 measures is at www.fazzi.com.