Speaker: Vera Barton-Caro, RN, MSN, C-FNP

On the Road Again—Learning Sessions Across Pennsylvania
All six spring learning sessions have been completed. Participant feedback was extremely positive and many attendees left the sessions with enthusiasm and the desire to spread knowledge throughout their agencies. This year's session was clinically focused on the management of the heart failure patient in accordance with the current evidence-based ACC/AHA, CMS and the Joint Commission standards for the treatment and discharge management of heart failure.

Program Design
The spring education program was designed to educate participants on the management of the heart failure patient/family in the home care setting with an emphasis on current treatment standards, staff competency, collaborative practice and transitions of care.

Program Purpose
The purpose of the program was to assist:  (1) nurses to polish their practices and further develop their clinical expertise related to heart failure and (2) leadership to recognize the vital importance of clinical expertise and competency that is congruent with current standards of practice to successfully manage heart failure or other chronic illnesses.

Chronic Care Model
Attendees were reminded of the Chronic Care Model – the emerging model for the delivery of chronic care across the country – and its connection to this presentation. The Chronic Care Model provides the support for a chronic care oriented system that includes a proactive practice team, informed active patients (self-care management support) and productive interactions between the practice team and the patient/caregivers.

If you have not had the opportunity to view the “Chronic Care Model and Home Care” WebEx presentation by Edward H. Wagner, MD, MPH, director of the MacColl Institute for Healthcare Innovation, it is posted on www.qipa.org. We encourage anyone who has not viewed this WebEx to schedule time for the opportunity.

Train-the-Trainer
Daily operations can make it difficult for agencies to send their busy clinicians to learning sessions. In an attempt to support agencies in providing this heart failure education optimally to all staff, a turnkey train-the-trainer section was provided to all learning session attendees. The training guide can be used as an independent self-study or be used in a group training setting. A companion DVD in a modular format, which contains the entire learning session presentation, is included with the written material. Agency staff that complete the training by July 15, 2008 are eligible to receive 4.5 continuing education units free of charge.

Program Faculty
The featured speaker for the education program was Vera Barton-Caro, RN, MSN, C-FNP. Ms. Barton-Caro is a nationally-known speaker on the topic of heart failure, as well as a practicing clinician and nurse manager of the Heart Failure Clinic in Wheeling, WV under the direction of Richard F. Terry, MD. She currently serves on the board of directors for the American Association of Heart Failure Nurses and is the current president-elect.

"I have been a cardiac nurse for (CCU & ICU) for 7+ years.  This is one of the most informative seminars that I have ever been to.  Thank you" – Ericka Gardner, Heartfelt Home Health

Due to the critical importance of clinically appropriate heart failure management, Quality Insights of Pennsylvania has developed a series dedicated to ongoing heart failure (cardiac-related) education for all Pennsylvania agencies. The heart failure education WebEx series will include the following:

Polish Your Practice – Heart Failure Series To be posted on www.medqic.org by mid-July 2008
Topic	Speaker
Current Guidelines for Therapy (three modules)	Vera Barton-Caro, RN, MSN, C–FNP Family Practitioner and Nurse Manager at the Heart Failure Clinic in Wheeling, WV, under the direction of Richard F. Terry, MD
Lipid Management	Carl Orringer, MD, FACC Case Western University Cleveland, Ohio
Pharmacological Interventions	Anna M. Wodlinger Jackson, Pharm D, BCPS Temple University Philadelphia, Pennsylvania
Nutritional Interventions	Stella L. Volpe, PhD, RD, LD/N, FACSM University of Pennsylvania Philadelphia, Pennsylvania

As the 8^th Scope of Work (SOW) winds down, we would like to show our appreciation to all the Pennsylvania agencies for their hard work on reducing acute care hospitalization rates and improving the management of oral medications in addition to other publicly reported outcomes.

To review, the focus in the 8^th SOW for all agencies in the nation was to reduce acute care hospitalization rates. Each state selected another publicly reported outcome;  Pennsylvania selected improvement in the management of oral medications. The majority of the Quality Excel agencies also selected improvement in the management of oral medications as their second measure.

The 9^th SOW will commence on August 1, 2008. This scope has some major changes from the previous Scopes of Work. The 7^th and 8^th SOW had specific measures for health care provider tasks. For example, in the 8^th SOW, home health agencies focused on reducing acute care hospitalizations, improving other publicly reported quality measures, improving immunization rates and systems improvement and organizational culture. Hospitals focused on improving surgical care, systems improvement and organizational culture, core measure improvement (acute myocardial infarction, heart failure, and pneumonia) and patient safety in critical access hospitals.

The 9^th Scope of Work is divided into four major themes and Quality Improvement Organizations (QIOs) will work with providers within the themes. The themes and types of interventions include:

Beneficiary Protection
In the 9^th SOW, QIOs will continue to carry out statutorily mandated review activities, such as:

• Reviewing the quality of care provided to beneficiaries
• Reviewing beneficiary appeals of certain provider notices
• Reviewing potential anti-dumping cases
• Implementing quality improvement measures as a result of case review activities.

Patient Safety
QIO activities under the Patient Safety theme will focus on six primary topics:

• Reducing rates of health care-associated methicillin-resistant staphylococcus aureus (MRSA) infections
• Reducing rates of pressure ulcers in nursing homes and hospitals
• Reducing rates of physical restraint use in nursing homes
• Improving inpatient surgical safety and heart failure treatment in hospitals
• Improving drug safety
• Providing quality improvement technical assistance to nursing homes in need.

Prevention
The Prevention theme consists of three focus areas:

• Core Prevention: Two cancer screenings (mammography and colorectal cancer [CRC] screening) and two immunizations (influenza and pneumoccocal) among Medicare Beneficiaries
• Diabetes Disparities: Sub-national component to provide Diabetes Self-Management Education (DSME) support for 33 states/jurisdictions experiencing disparities in diabetes care across racial/ethnic populations
• Chronic Kidney Disease (CKD): Sub-national quality improvement effort for up to 13 QIOs to slow the progression of CKD and to improve CKD clinical care.

Care Transitions
The Care Transitions theme focuses on improving coordination across the continuum of care by promoting seamless transitions from the hospital to home, skilled nursing care, or home health care. Additionally, the charge will be to reduce unnecessary readmissions to hospitals that may increase risk or harm to patients and cost to Medicare. Eighteen states/jurisdictions will receive contracts for this theme project.

Specific projects will be to implement process improvements in:

• Medication management
• Post-discharge follow-up
• Plans of care for patients who move across health care settings.

While the intensity of the work currently done with the QIO may change for many home health agencies, there are abundant opportunities for every home health agency to continue improvement. Quality Insights of Pennsylvania will provide agencies with current evidence- or literature-based resources to support quality improvement efforts for the next several years. We are developing new educational resources, including webinars and forms and templates, which will promote agency independence with continuous quality improvement. The resources will be available by mid-July on www.medqic.org, and an announcement will be sent to all home health agencies with location and access information for the new resources via the PA listserv. Many of these resources are clinically focused, so agency leadership should promote these with their staff. Additionally, the Home Health Quality Improvement Best Practice Intervention Packages (BPIPs) and all associated resources will remain available on www.medqic.org. There are a multitude of resources available in the BPIPs! Additionally, the BPIPs have agency self-assessments and action items. Agency leadership may want to periodically review these items to enhance and revitalize current processes.