Think Holistic, Think Patient-Centered, Think FAST!

Yang Chen, Sara Hanrahan, Cathy Ng, Sophia OlsenCLARION Case Competition

Spring 2015

Overview

● Patient Case

● Root Cause Analysis

● Recommendations & Implementation

● Financial Assessment

● Conclusion

Lynette’s Story

Lynette Tate53 yo FemaleDx: Left hemisphere

ischemic stroke

Disease Onset

• Low health literacy • Low awareness of disease prevention

Hospital admission

• Symptoms-centered care• Healthcare team lack communication and coordination Di

scharge/Rehab

• Lack proper patient education on disease state and follow-up care• Lack proper communication between facilities

Homecare

• Failure to receive therapy• Receiving wrong dosage of insulin

Patient’s Health Decline

StrokeNationally

● Kills approximately 130,000 Americans yearly● 4th leading cause of death● $34 billion each year in costs:

o health care serviceso medications o missed days of work

● 87% of all strokes are ischemic strokeso when blood flow to the brain is blocked

● The highest death rates from stroke are in the southeastern US

Kentucky

● Department of Public Health o William D. Hacker, MD, FAAP, CPE

Commissioner● Kentucky Heart Disease and Stroke Prevention

State Action Plan 2011-2016

Kentucky Heart Disease and Stroke Prevention State Action Plan 2011-2016

● Kentucky is plagued with the status of being an unhealthy state.

● It ranks 6th in heart disease and 10th in stroke mortality.

● Focus on the CDC’s priority areas for heart disease and stroke.

● The KHDSP Program partnered with the Northern Kentucky CARE (Cardiovascular Assessment, Risk Reduction and Education) o Designed to provide blood pressure

awareness educational encounters within the community

Our Mission● To deliver care in a holistic,

patient-centered, and outcome-oriented manner ensuring accessibility, reliability, and affordability.

Root Cause Analysis

Problem: ● Non-optimal care

Patient Factors:● Low awareness of

disease state/ symptoms

● Diet/lifestyle● Low health literacy● Miscommunication● Lack of education

Provider Factors:● Not patient-centered● Partial assessment● Delayed intervention● Rushed education

System Factors:● Non-streamlined care● Misconception of care● Lack of care

coordination● Lack of resources

Community Efforts:● Low awareness, no

perceived need● Community

Outreach/Education● Low overall health

Recommendations & Implementation

Patient Factors

Optimal care: ● Help patient to maintain a

healthy lifestyle through diet and exercise

● Preventive care

Our recommendations:● Involve patient in their

therapeutic care plan● Improve patient’s

compliance & understanding

Interventions at Patient Level● Patient/Family Education● Use a plain language● Use teach-back method to confirm patient’s understanding● Tests and screenings

Community Efforts

Optimal care:● Raise awareness of strokes

and its impact● Provide professional advice

to the general public● Encourages the pursuit of

overall wellness in life

Our recommendations:● Community outreach

and education

Interventions at Community Level● Education focus on the modifiable risk factors associated

with stokes, such as cardiovascular disease, high cholesterol, smoking, obesity, hypertension, and diabetes

● Wellness fair● Medication take-back

Provider FactorsOur Recommendations:

● Increase interprofessional communication

● Build trust and foster a good provider-patient relationship

Optimal Care:● Patient-centered care

plan● Interprofessional

communication● Tailored patient education● Thorough assessments● Use of diagnostic studies● Holistic approach to

patient care

Interventions at Provider Level● Hiring a Stroke Specialist● “My Care Board”, highlighting: diet status, tests/screenings

yet to be performed, anticipated discharge date● Multidisciplinary daily rounding

○ Weekly plan of care (POC) meetings● Interprofessional inservices● Emphasis on holistic care

System FactorsOptimal Care: ● Delivery of comprehensive

health care services that are well coordinated

● Good communications among healthcare providers

Our recommendations:● Continuity and

Coordination of care● Follow-up/Transitioning

care

Interventions at System Level

● Unified Electronic Medical Record (EMR)● Having sufficient trained staff for each health

care discipline● Transfer/Discharge Checklists● Home evaluations

Financial Assessment

Why these cost would be good investments?

Initial hospitalizationRehabilitationPhysician CostsHospital ReadmissionMedications and other expenses

43%16%14%14%13%

Breakdown of the direct costs of care for the first 90 days after a stroke:

Model adopted from The Stroke Center at University Hospital, Newark, NJ

Financial Budget+ $ 184,864 (Stroke Specialist Salary x 1)+ $ 61,534 (Occupational Therapist Salary x1)+ $ 65,388 (Physical Therapist Salary x1)+ $ 123,750 (Max. EMR Implementation cost)- $ 110,162 (Aspiration Pneumonia x13) - $ 428,572 (Readmission Rate Savings / year)

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$ 103,198 in Savings annually!

Contracting ArrangementsTraditional fee for service (Current)• DRG type payment for the initial hospitalization• Negotiated fee schedule with providers

Bundled payment arrangement (Alternative)• Defined amount of money for all of the care

Conclusion

Stroke in South Tree Health Network

Improve performance related to the Triple Aim:● Improve the patient experience

o Clinical quality and patient satisfaction ● Improve the health of the population

o Collaborate with Kentucky Action Plan● Improve affordability of care

o Streamline South Tree Health Network

Moving forward...● Re-assessment of our implementation in 6, 12, 18

months to see if this model is working.● Replicate/modify this model for other chronic diseases like diabetes and hypertension.

Questions