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Creating Partnerships to Promote Quality

Creating Partnerships to Promote Quality. Debbie Solomon, RN, MSN, CNP Beth Peterson, RN, MSN, MA Bonnie Westra, RN, PhD. Objectives. Learn outcome based quality improvement principles and approaches.

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Creating Partnerships to Promote Quality

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  1. Creating Partnerships to Promote Quality Debbie Solomon, RN, MSN, CNP Beth Peterson, RN, MSN, MA Bonnie Westra, RN, PhD

  2. Objectives • Learn outcome based quality improvement principles and approaches. • Get examples of combining expertise from clinical practice and academia in improving homecare patient outcomes. • Define and understand mutual benefits from partnerships between academic institutions and home care agencies.

  3. Who are we? • Home Care Agency • University-Clinical • University-Research Fairview Lakes HomeCaring & Hospice

  4. Who are we? • Home Care Agency • University-Clinical • University-Research

  5. Who are we? • Home Care Agency • University-Clinical • University-Research

  6. Quality Improvement • Principles and Approaches • QI-OBQI

  7. Quality Improvement • Outcomes • Health Status Change between 2 or more points in time • Changes intrinsic to the patient • Positive, negative or neutral • Changes result from care provided, natural disease progression, or both

  8. Quality Improvement • Tools • OASIS • EHR

  9. OBQI

  10. OBQI Process

  11. So What? QI in Real Life

  12. GIGO

  13. Bethel

  14. Research - Hospitalization • The purpose of this study was to develop predictive models for risk factors associated with increased likelihood of hospitalization of homecare patients and discover if interventions documented as part of routine care using the Omaha System influence hospitalization.

  15. Agency Characteristics

  16. Agency Characteristics Referral Source

  17. Interventions Agency Characteristics Referral Source

  18. Omaha System

  19. Selecting Outcomes

  20. Data Source • Secondary analysis of EHR data • OASIS and Omaha System interventions from two different EHR vendors and 15 homecare agencies. • Data included • All open charts in 2004 for patients with a minimum of two OASIS records for the start and end of an episode of care and who also had Omaha System interventions.

  21. Initial Data • 18,067 OASIS records for 3,199 patients • 989,772 Omaha System Interventions • 65,000 Medication records

  22. Data Preparation

  23. Clinical Validation of Working with Data • Episodes of care – unit of analysis • Summative scales • Clinical Classification Software - primary diagnoses and then reduced into 51 smaller groups within 11 major categories • Charlson Index of Comorbidity - additional medical diagnoses • Interventions theoretically grouped into 23 categories

  24. Episodes

  25. Episodes

  26. Scales • Prognosis (M0260, M0270) • Pain (M0420, M0430) • Pressure Ulcers (M0450 – M0464) • Stasis Ulcers (M0470 – M0476) • Surgical Wounds (M0484 – M0488) • Respiratory Status (M0490 – M0500) • ADLs (M0640 – M0710) • IADL (M0720 – M0770)

  27. Primary Diagnoses

  28. Clinical Classification Software

  29. Charlson Index of Comorbidity

  30. Applying a clusterer: Identifying similarities and dissimilarities

  31. Applying a Clusterer: Identifying similarities and dissimilarities

  32. Class III: Cardiac/ Circulatory

  33. Significant Interventions Class III: Cardiac/ Circulatory

  34. Interpreting Results • Latent Classes – are they meaningful? • What does it mean to have bowel incontinence as a predictor of hospitalization? • Across classes: most consistent predictors of hospitalization are • Charlson Index of Comorbidity, • Prognosis • Medicare • Patient management of equipment • IADLs

  35. Conclusion • Academia has much to offer • Research methods and resources • Clinical practice is the heart of research • Provide meaningful questions • Source of data for research • Interpretation of steps in the process and results

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