Entries in Clinical & Quality (53)

Thursday
May172018

Medication Nonadherence: Data and Analytics Can Make an Impact

By Claire Thayer, May 16, 2018

Over two-thirds of hospital readmissions are directly due to medication nonadherence.  Many factors contribute to patients not taking their medications, including fear of side effects, out-of-pocket costs, and misunderstanding intended use.  Interventions targeted at understanding the underlying causes on nonadherence are critical to improving chronic disease outcomes.  Successful interventions include: educating patients on purpose and benefits of treatment regimen, reducing barriers to obtain medication, as well as use of health IT tools to improve decision making and communication during and after office visits. 

This weeks’ edition of the MCOL infoGraphoid, co-sponsored by DST Health, explores how data and analytics can provide insight to drive behavior change to improve adherence.

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
May042018

Welcome to Lifestyle Medicine

By Clive Riddle, May 4, 2018 

The May issue of Circulation includes the research article: Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population, which presented findings from a study that aimed “to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population.” 

Using data from previous studies they defined five low-risk lifestyle factors

  1. never smoking
  2. ≥30 min/d of moderate to vigorous physical activity
  3. moderate alcohol intake
  4. a high diet quality score (upper 40%)

The study “estimated hazard ratios for the association of total lifestyle score (0-5 scale) with mortality,” and used available national public databases to estimate life expectancy by levels of the lifestyle score, examining mortality of 42,167 adults. 

They found the females who adopted all five of these low risk factors would at age 50 live 14.0 more years that those who adopted zero of the five; and that men at age 50 who adopted all five would live 12.2 years longer than those who adopted zero. They “estimated that the life expectancy at age 50 years was 29.0 years for women and 25.5 years for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years for women and 37.6 years for men.” 

With these findings in mind, let’s stop by the American College of Lifestyle Medicine (ACLM), established several years ago as “the professional medical association for those dedicated to the advancement and clinical practice of Lifestyle Medicine as the foundation of a transformed and sustainable healthcare system.” They tell us that “Lifestyle Medicine involves the use of evidence-based lifestyle therapeutic approaches.” 

ACLM and Blue Shield of California have just announced a collaboration “to provide Lifestyle Medicine continuing medical education and other training tools to the nonprofit health plan’s in-network healthcare providers.” They tell us that “with this new collaboration, Blue Shield becomes the first health plan to offer its in-network healthcare professionals access to discounted ACLM courses, membership, conference registration, board certification review coursework and registration for the American Board of Lifestyle Medicine exam.” 

In November last year, ACLM announced the first physicians and health professionals to be board-certified in the field. They also have developed True Health Initiative (THI), “a coalition of world-renowned health experts committed to cutting through the noise and educating on only the evidence-based, time-honored, proven principles about lifestyle as medicine. The ultimate mission of the THI is to eliminate as much as 80% of all lifestyle-related chronic disease through lifestyle as medicine.”

 

Friday
Apr272018

Nine Things to Know Jump Out of Leapfrog Hospital Safety Grade Report

Nine Things to Know Jump Out of Leapfrog Hospital Safety Grade Report
 

By Clive Riddle, April 27, 2018

 

In May talk of frogs would lead one to the annual Calaveras Jumping Frog Jubilee (check out www.frogtown.com). But in April, talk of frogs leads one to The Leapfrog Group, who just released the spring 2018 edition of the Leapfrog biannual  Hospital Safety Grades. Leapfrog tells us their “grading assigns “A,” “B,” “C,” “D” and “F” letter grades to general acute-care hospitals in the U.S., and is the nation’s only rating focused entirely on errors, accidents, injuries and infections that collectively are the third leading cause of death in the United States.”

 

Here’s nine things to know from the Leapfrog report card results they have shared:

1.     Five “A” hospitals receiving this grade for the very first time this spring had an “F” grade in the past

2.     46 hospitals have achieved an “A” for the first time since the Leapfrog Hospital Safety Grade began six years ago

3.     89 hospitals receiving an “A” at one point had received a “D” or “F”

4.     Of the approximately 2,500 hospitals graded, 30 percent earned an “A,” 28 percent earned a “B,” 35 percent a “C,” six percent a “D” and one percent an “F”

5.     The five states with the highest percentage of “A” hospitals this spring are Hawaii, Idaho, Rhode Island, Massachusetts and Virginia

6.     Rhode Island, Hawaii, Wisconsin, and Idaho once ranked near the bottom of the state rankings of percentage of “A” hospitals but now rank in the top ten

7.     Hospitals with “F” grades are located in California, Washington, D.C., Florida, Iowa, Illinois, Maryland, Michigan, Mississippi, New Jersey and New York

8.     There are no “A” hospitals in Alaska, Delaware or North Dakota

9.     Impressively, 49 hospitals nationwide have achieved an “A” in every grading update since the launch of the Safety Grade in spring 2012

 

In addition to staterankings, you can search for specific hospital safety results at their webaite: http://www.hospitalsafetygrade.org

 
Wednesday
Apr252018

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview
 

Last week, Erin Benson, Director Marketing Planning and Rich Morino, Director, Strategic Solutions, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on opportunities for health plans to leverage social determinants of health data to attain quality goals while managing cost and enhancing member experience.  If you missed this engaging webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Erin and Rich on five key takeaways from the webinar:

 

1. What are some of the ways that member health is impacted on a daily basis by social, economic and environmental factors?

 

Erin Benson and Rich Morino: The environment in which a person lives impacts their likelihood to develop health conditions as well as their likelihood to effectively manage those conditions. Care recommendations need to be a good fit for a member’s environment, not just their medical condition. If recommendations won’t work within the person’s physical environment, aren’t affordable or conveniently located, and are provided in a way that is hard for the member to understand, they won’t be effective at improving health. Studies support this fact. For example, 75-90% of primary care visits are the result of stress-related factors (JAOA Evaluating the Impact of Stress on Systemic Disease: The MOST Protocol in Primary Care). Money, work and family responsibilities – all reflective of social determinants of health -- are cited as the top three causes of stress (APA 2015).

 

2. We've heard reference to aggregating data at the zip code level for use in personalizing care for members. However, this is one of your top five myths about socio determinants of health. Can you tell us more?

 

Erin Benson and Rich Morino: While aggregate data can be useful in certain capacities, it isn’t recommended as a best practice for personalizing care. Within a single zip code, it is not unusual to see variance in income levels, crime rates and other factors impacting an individual’s neighborhood and built environment, so we recommend looking at an individual’s neighborhood from the perspective of their specific address. Focusing on zip code alone also ignores the influences of education, economic stability and social and community context so we recommend incorporating these other social determinants of health into decision-making in order to view the member holistically and create a more comprehensive plan of care outreach.  

 

3. Can you briefly explain why previous generations of SDOH have failed to improve health outcomes?

 

Erin Benson and Rich Morino: There are two primary reasons why previous generations of SDOH have failed to improve health outcomes, data and workflow.   In order to get sufficient value, the data needs to address all 5 categories of SDOH to properly draw useful insights.  The data should also be at the member level, and address who the member’s family and close associations.  Without that information, we cannot tell if someone is socially isolated or living with caregivers, for instance.

 

The second reason why previous generations of SDOH have failed is how they are deployed in the workflow.  An example would be a plan simply adding them to an existing claims-based model to achieve an increase in lift.  The lift is nice, but no changes in process are filtering down to the Care Management team interacting with the members.   In this scenario, a lot of value was ignored.

 

A better method would be if the plan also built models identifying members with barriers to improved health outcomes.  If you now apply this to your chronic or at-risk population you can determine not just who is sick and in need of help, but how to most likely achieve success in an intervention program.  Care Managers would immediately know the challenges to success, and what type of intervention program the member should be in enrolled in from the start.

 

4. One of the SDOH models to uncover health barriers referenced during your webinar was social isolation. Can you provide more context for us here?

 

Erin Benson and Rich Morino: Studies have shown that social isolation can increase risk of heart disease by 29% and stroke by 32% (New York Times How Social Isolation Is Killing Us). By understanding factors about an individual such as who else is living in the household with them, their predicted marital status, and how close their nearest relatives and associates live to them, healthcare organizations can identify who may be socially isolated. This allows care providers to ask the right questions to determine if that person needs access to social support systems such as support groups or community resources to improve their health outcomes.

 

5. What are some ways social determinants can help health plans enhance predictions and improve care management?

 

Erin Benson and Rich Morino: The most common way of utilizing SDOH data so far has been to incorporate it into existing claims-based predictive models to improve predictive accuracy or to use it to create new predictive models. The second use is for care management purposes and this is where social determinants of health can be truly transformational. We recommend as a best practice to use social determinants of health insights to also build models that identify health barriers. The combination of models allows healthcare organizations to better stratify the risk of their members and then better tailor care to their medical and social needs.

 
Friday
Mar022018

Five Questions for Patrick Horine, CEO DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, March 2, 2018

This week, Patrick Horine, CEO DNV GL Healthcare, participated in a Healthcare Web Summit webinar panel discussion on Leveraging Hospital Accreditation for Continuous Quality Improvement webinar. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

1. What is ISO 9001 and how is this closely related to strategic goals for hospitals?

Patrick Horine: Goals are just goals unless there are objectives in place to be measured and met to achieve them.   The ISO 9001 quality management system (QMS) is the means for managing the objective to determine the needs of and desires for customers.    The ISO 9001 QMS is customer focused and to ultimately enhance patient satisfaction.    Engaged employees means more patient satisfaction.   Enhance patient satisfaction increase HCAHPS scores.   Increased HCAHPS scores are what provide the financial and reputational incentives for hospitals.    Given the current challenges with reimbursement and the competitive climate it is imperative for hospitals to ensure the patient experience and satisfaction is best as it can be.  Quality objectives are at every level of the organization.  They may apply broadly across the organization or more narrowly.   The goal may be the result but there are a lot of contributors to ensure the goal is attained.    Quality objectives are specified and aligned with the goals to enable the measuring and monitor of progress to evaluate progress.

2. What are some of the benefits and challenges associated with implementing ISO 9001?

Patrick Horine: In short, I would note the following:

  • Improving consistency
  • Added accountability
  • Increasing efficiency
  • Engagement of Staff

What drove us to consider integrating this within the accreditation process was because the hospitals we were working with could make improvements or address compliance but they had a more difficult time sustaining what they put in place.    ISO 9001 requires such things as internal auditing and management review are two of the most impactful aspects for the ISO 9001 requirements.  

Through these internal audits and then reflecting the success of the actions taken with the management reviews will lead to more consistent practices through the organization.   It is not uncommon see multiple versions of similar policies all throughout the hospital.  Are they really different?   Likely not, so reducing these to one practice will improve consistency.    I often ask groups “How many of you think you follow your policies and procedures exactly as they are written?”   Rarely, if ever, would you see anyone state they did.   So, if we don’t then why do we have them?   If we need to have them, as we really do, then they should be written, communicate, implemented and measured to ensure they are being consistently followed.   Without fail, doing so will lead to better results in some manner.

Simplification and consistent processes lead to more efficient operations of the hospital.   Hospitals or any organization for that matter that considers the quality management to be an integral part of their business operations will commonly achieve more efficiency than those that do not.

Gaining this understanding of the processes and getting to the efficiency is not possible without the involvement of those closest to them.    As an organization, if we strive to improve every day, it is imperative that the staff are engaged so they can be directly involved to improve their work to be more satisfied with what they do and their contribution to the success of the organization.   

Happy wife = Happy life, the same holds true with Happy employees = Happier patients.    Those who are more involved with improving of the processes they work with are happier and more engaged employees. Engaged employees are more productive when they are identifying improvements to be made and how to go about making them.  

Challenges

  • Culture not conducive to change
  • Making it more complicated than it needs to be
  • Too many details

Can an organization implement ISO 9001 overnight?  No.   This is something that will leadership commitment, engagement of staff, willingness to be self-critical, ability to break with traditional thinking.    More easily described, the culture of the organization must be such that you are open to change, making improvements and have patience to know the quality management system will mature over time.   

What seems to be more universal thinking among us healthcare people, if it is not difficult then we will find a way to make it so somehow.    In my opinion, I think the ISO 9001 standard has evolved with each revision to be more and more befitting to healthcare than other industry sectors.    Process thinking, sequence and interactions, risk-based, competence of staff, customer expectations and satisfaction.   It fits.   We have much of what ISO requires already in place but still some work to be done.   This does not require wholesale changes so we don’t have to make it more difficult.   What is working and what is not working is a critical step because we must understand where improvements or change need to be made.  

Like I mentioned, policies and procedures are rarely followed exactly as they are written, but some are written as works of literature with elaborate detail.   Simplify, a 30-page policy is more effective when adapted to a 2-page work instruction.   More likely that one would read it, better opportunity for it to be consistently applied.    That is not to say that some we rid ourselves of all policies and procedures but rather don’t add complexity to what we already have and ask what we need to really keep.   

3. How does ISO 9001 hold hospitals accountable for meeting CMS requirements?

Patrick Horine: ISO 9001 itself does not address the CMS Conditions of Participation (CoPs).    All hospitals are accountable for compliance if they want to bill and be reimbursed under Medicare & Medicaid.   All CMS approved accreditation organizations must develop standards that meet or exceed the CMS CoPs.  Some choose to have more extraneous requirements, others apply the minimum.   DNV GL Healthcare wanted to have a standard that would meet the CoPs but we have integrated the ISO 9001 to the accreditation process and made this a requirement for hospitals under our program.  Compliance to the CMS requirements should be the by-product of a good quality management system and this is where ISO 9001 can be most effective. 

The ISO 9001 helps organizations have a more robust quality management system in place where compliance should be more of a by-product then the end goal.   Our thinking was that hospitals are often not complying with the minimum requirements to be met and these are what are fundamental to the organization to have provide safe and effective care.    To be more consistent meeting the fundamental requirements is the first challenge.   Going beyond, rather than more prescriptive requirements, the CoPs can be the parameters and the organization can me innovative to put practices in place.  We can still hold the hospital accountable meeting the CoP and then see how they demonstrate the effectiveness and outcomes of what they have in place.  

4. While the accreditation process for hospitals is part of Medicare / CMS program requirements, are there any plans to accredit hospital labs, physician clinics, or long term care organizations?

Patrick Horine: We currently have CMS deeming authority for acute care and critical access hospitals.   Next, we will complete the process for securing deeming authority for Psychiatric Hospitals and then Ambulatory Surgery Centers.   Most likely will not purse approval under CLIA for laboratories, but always possible.   There is desire to be more certification programs with physician/medical clinics and other providers.   Presently these would be self-governed as there is no deeming authority for such medical offices nor long term care.   I believe additional quality measures and oversight would make an impact in these environments.

5. How is DNV GL different from the Joint Commission and are there other accrediting organizations?

Patrick Horine: The more evident differences would be:

  • Annual surveys vs. once every 3 years
  • Less prescriptive standard more closely aligned to the CoPs – but inclusive of some additional requirements as well as maintaining compliance with ISO 9001
  • Demeanor of our surveyors
  • No types of accreditation; preliminary denial, conditional accreditation, double secret probation

It is better to describe those differences as told to us by those we have accredited, so I will use some of their quotes;

 “With DNV GL the surveys have been more meaningful and more consistent”

  • “It is nice get away from an inspection oriented approach but still be thorough”
  • “DNV GL is not easy but is easier to get along with”
  • “We have appreciated more of a collaborative process rather disciplinary one”
  • “We want to learn from the surveyors and how we can do better”
  • “The annual surveys help keep us focused on compliance and we do less getting ready for surveys”

“Doing things for the right reason not because of … have to”