The monthly Home Health Quality Improvement (HHQI) reports will continue to be mailed to your agency through July 2008. The reports will look the same, but they will have a different name.

The HHQI Web site, www.homehealthquality.org, will remain on the Web until July 31, 2008. Currently, all HHQI resources are being transferred to www.medqic.org and will remain on the MedQIC site for the foreseeable future. However, it is always a good idea to make copies of the resources on a hard drive and/or CD(s).

Below are some “next steps” to help your agency continue to work towards quality improvement.

Twelve monthly Best Practice Intervention Packages (BPIPs) were provided for agencies during the HHQI National Campaign to assist agency leadership in implementing and optimizing the top 12 best practices for reducing hospitalizations.

Even though this yearlong campaign has concluded, the resources will remain available and continue to be pertinent. The BPIPs and associated resources will remain available on www.homehealthquality.org until July 31, 2008 and will be available beginning in early February 2008 on www.medqic.org (under Home Health). Each BPIP includes a significant amount of information that agencies can continue to use for ongoing quality improvement activities. The following are suggestions for evaluating future activities:

• Take time to reflect on the interventions and changes that have already been implemented to assist with reducing ACH
• Evaluate compliance and consistency with interventions and changes that have already been initiated
• Evaluate the BPIP topics that have been identified as a focus area and review the package again, selecting additional action items
• Review the full BPIPs if only the Fast Track was previously used
• Incorporate BPIP action items into the annual quality improvement plan:

• Use the Care Tracks for orientation and staff competencies
• Develop a competency fair using the resources from the packages
• Collect all packages together in a resource binder
  

The 2008 scope of education will continue to target best practices for the reduction of acute care hospitalization, building upon the foundation provided in the final three Best Practice Intervention Packages—Building Upon the Basics:  Patient Self-Management, Disease Management and Transitional Care Coordination. The educational focus for spring 2008 will be on chronic illness management with an emphasis on the clinical management of heart failure (HF). Management of chronic illness, especially heart failure, can assist your agency in reducing your acute care hospitalization rates.

Because the knowledge of chronic illness management strategies is critical for receiving optimal benefit from the learning sessions, the instruction will be provided in two parts:

• Part I:  The Chronic Care Model and Home Health WebEx/teleconference
• Part II:  Disease Management:  Heart Failure Presentation (regional learning sessions)

Part I:  Chronic Care Model and Home Health

(Edward Wagner, MD, MPH, Director, MacColl Institute for Healthcare Innovation)

Fact:  More than 125 million Americans suffer from one or more chronic illnesses and 40 million are limited by those illnesses.

Fact:  Despite annual spending of nearly 1 trillion dollars and significant advances in care, one-half or more of the patients still don't receive appropriate care.

Fact:  Your agency is currently providing service to patients with chronic illnesses.

Question:  Are you and your staff at the top of your game in terms of chronic illness knowledge, assessment and treatments?

Question:  Have you heard of the Chronic Care Model by Edward Wagner, MD, MPH?

Question:  Do you understand the significance of the Chronic Care Model to home care?

Dr. Wagner will be the featured speaker for the WebEx/teleconference. He will discuss the significance of the problem of chronic care in America and who is responsible for meeting the challenges posed. The Chronic Care Model will be explored as to how it works, does it work and how home health can make it work.

The Chronic Care Model and Home Health WebEx/teleconference is also pre-work for the upcoming learning session that will focus on Disease Management. The learning session will build upon the understanding of chronic diseases.

Wagner, E.H. Chronic disease management: What will it take to improve
care for chronic illness? Effective Clinical Practice. 1998. 1:2-4.

Part II:  Disease Management Learning Sessions:  Heart Failure

Fact:  Despite current treatments and interventions, heart failure (HF) continues to be a progressive illness with an unpredictable trajectory and high mortality rate.

Fact:  Approximately 5.2 million Americans have heart failure, representing an incidence of 10 per 1,000 in the population older than 65 years of age (AHA, 2007).

Fact:  Heart failure accounts for more hospitalizations than any other condition and carries a high mortality rate, with one in five people dying within one year of diagnosis and approximately 50 percent dying within five years (AHA, 2007).

Question:  Do you understand the significance of remaining current with the state of the art HF management in home care?

Question:  Do you and your staff desire to polish your HF management practices related to pathophysiology, diagnosis, assessment, classification, treatment guidelines, medication management, end of life issues and the future of HF treatment?

If you answered “yes” to either of the questions above or were surprised by the three facts, then you want to attend one of the regional spring 2008 learning sessions!

Learning Session #5:  Quality Insights of Pennsylvania Ready, Aim Improve:  Acute Care Hospitalization Program Presenter:  Vera Barton-Caro, RN, MSN, C-FNP

Registration is available on www.qipa.org under Home Health.
Register early, space is limited!!!

The Home Health STAR Web site has been updated to reflect the December 2007 changes to Home Health Compare. The December 2007 Home Health Compare update includes OASIS data from July 2006-June 2007.

There are two new measures on Home Health Compare. They are:

1. Percentage of patients whose wounds improved or healed after an operation (which is the OBQI measure-Improvement in Status of Surgical Wounds)
2. Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected (which is the OBQM measure-Emergent Care for Wound Infections, Deteriorating Wound Status)

Home Health STAR has always included “Improvement In Status of Surgical Wounds” as a measure for target setting along with the additional information about the OASIS item (understanding the measure and CMS Q&As).

Home Health STAR will not include target-setting capability for Emergent Care for Wound Infections, Deteriorating Wound Status. However, the resources of “understanding the measure” and the CMS Q&As related to the measure have been added. These can be found by logging into STAR, then going to “My Data Comparison” for Emergent Care. Choose “Additional information about the OASIS item(s) related to this quality measure.” This will contain information for “Any Emergent Care and Emergent Care for Wound Infections, Deteriorating Wound Status” (begins on page 7).

Please contact Quality Insights for STAR access login information if your agency has not previously accessed Home Health STAR. Home Health STAR can be found at www.medqic.org, under Home Health where you will find a link to the Home Health STAR Web site.