Post on 12-Apr-2022
transcript
Ready, Set, Go! Getting (Re)Started with TAKEheart
Combined Module 1 & 2
Kim Newlin, RN, CNS, ANP-C Hicham Skali, MD, MSc
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Welcome Partner Hospitals!
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Today’s Event
Background TAKEheart launched in January 2020. Module 1 was delivered in January 2020 followed by Module 2 in February 2020. Due
to the COVID-19 Public Health Emergency, TAKEheart paused training activities in March 2020.
Today TAKEheart resumes with a condensed version of Modules 1 and 2. Participating hospitals continue process of learning and sharing with each other.
TAKEheart website https://takeheart.ahrq.gov/
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PARTICIPANTSMODULE 1 RECAP
Cardiac Rehabilitation Change Package (CRCP): Roadmap for Training
The training, educational resources and technical assistance offered by TAKEheart are designed to support the implementation of evidence-based strategies contained in the Million Hearts®/AACVPR Cardiac Rehabilitation Change Package (CRCP).
Access the Change Package at: TAKEheart Website Resource Center
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PARTICIPANTSMODULE 1 RECAP
CRCP Overview
Produced by Million Hearts in collaboration with American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) board members, headquarters staff
Contributions from over 20 hospitals/health systems 100+ tools and resources: AACVPR strategies Case studies Program specific tools Organization specific tools: CDC, AHA, ACC
Expertise, tools, and resources from: 18 states 22 institutions 36 CR professionals and researchers
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Instructional Format
EVERYONE LEARNS
• Training Curriculum• 10 modules to guide the
implementation of automaticreferral and effective carecoordination
• Implementation Guides• Supplemental documents for
each module, which outline thecontent, and provide specificactions, steps and resourceshospitals can use to assist withthe project.
EVERYONE SHARESEVERYONE SUPPORTS
• Partner Hospital Peer ActionGroups (PH PAGs)• Small groups of hospitals
meet monthly with a coach• Discuss the most recent
module content• Share ideas and offer
support to other hospitalsin the group.
Summary of Training Curriculum Foundational Activities
Module 1: Welcome to the TAKEheart Initiative and the Benefits of Increasing Cardiac Rehabilitation Participation Module 2: Systems Change: Creating a Team and Plan to Support Systems Change Module 3: Systems Change: Understanding Your Workflow Processes to Prepare for Systems Change Module 4: Systems Change: Preparing and Understanding Your Data to Foster Systems Change Module 10: Options to Expand System Capacity and Patient-Centeredness
Automatic Referral Implementation and Refinement Module 5: Building and Implementing a Successful Automatic Referral System Module 7: Troubleshooting Your Automatic Referral System
Effective Care Coordination Implementation & Refinement Module 6: Laying the Groundwork for Effective Care Coordination Module 8: Implementing Care Coordination Module 9: Engaging and Empowering Patients and Families for Success in Cardiac Rehabilitation
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American Hospital Association (AHA)/Health Research and Education Trust (HRET): TAKEheart AHRQ’s Initiative to Increase Use of Cardiac Rehabilitation Ready, Set Go! Getting Started with TAKEheart Module 1 & 2 May 27, 2021
The planners and faculty of TAKEheart Initiative Module 1 & 2 indicated no relevant financial relationships to disclose in regard to the content of their presentations with the exception of:
Hicham Skali,MD, MSc, faculty for this educational event, received a research grant from ABT Associates. This presentation has been reviewed and is found to contain no bias. There are no other relevant financial relationships to disclose regarding the content of this presentation.
Kim Newlin, RN, CNS, ANP-C, faculty for this educational event, received consulting fees from Kinetix. She also received consulting fees and speaker fees from Boehringer-Ingelheim. This presentation has been reviewed and is found to contain no bias. There are no other relevant financial relationships to disclose regarding the content of this presentation.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and American Hospital Association (AHA) / Agency for Healthcare Research and Quality (AHRQ). ABQAURP is accredited by the ACCME to provide continuing medical education for physicians.
The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 1.0 contact hours through the Florida Board of Nursing, Provider # 50-94.
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PARTICIPANTSLearning Goals
Learning Goals Upon completion of this module, you should be able to:
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Understand TAKEheart and the opportunity it provides to close the gap between evidence and practice to increase patient participation in cardiac rehabilitation.
Make the case to your leadership for taking active steps to increase CR participation by implementing automatic referral and care coordination support and begin to build buy-in among other members of your implementation team.
Understand the role of CR champion in the quality improvement project.
Identify key members of a multidisciplinary CR QI team, e.g., representatives from key departments and patient advisors.
Create an aim statement as part of an overall action plan for implementation of automatic referral with effective care coordination.
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PARTICIPANTSINTRODUCTIONS
Today’s Presenters
Hicham Skali, MD, MSc TAKEheart Principal I nvestigator, Associate
Director of the Cardiac Rehabilitation Program at Brigham and Women’s Hospital,
Division of Cardiovascular Medicine
Kim Newlin, RN, CNS, ANP-C
Director of Nursing Clinical Operations at Sutter Roseville Medical Center
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PARTICIPANTSData Tracking for Quality ImprovementFOR HOSPITALS/HEALTH SYSTEMS: Data for Quality Improvement, Reporting
Ready, Set, Go!
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Audience Question 1
Question 1: What best describes your feelings about the TAKEheart project?
Please select your answer here
Remember to click SUBMIT when complete
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Audience Question 2
Question 2: As you resume TAKEheart, what do you anticipate being your biggest challenge?
Please select your answer here
Remember to click SUBMIT when complete
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What is TAKEheart?
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PARTICIPANTSEVIDENCE-BASED APPROACH
The Opportunity: How to Close the Gap
EVIDENCE-BASED APPROACH
• Automatic referral: EMR based referralbuilt into order set, default, opt-outmodel where ALL patients withqualifying diagnoses are referred andrelevant providers are notified
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PARTICIPANTSEVIDENCE-BASED APPROACH
The Opportunity: How to Close the Gap
EVIDENCE-BASED APPROACH
• Care coordination support: Can be dedicated staff or someone in- house taking on role with appropriate training on program. Meets with patient to introduce CR and coordinate referral.
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PARTICIPANTS
The Opportunity: How to Close the Gap
EVIDENCE-BASED APPROACH
• In a 2011 study, implementing automatic referralto CR increased participation to 70% compared tocontrol (32%). Automatic referral with carecoordination support increased participation to86%.
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PARTICIPANTSFOR SYSTEMS AND SOCIETY
FOR SYSTEMS& SOCIETY
Making the Case for Cardiac Rehabilitation
FOR HOSPITALS/HEALTH SYSTEMS • National guidelines indicate that CR is a class 1a
recommendation (AHA/ACC) for MI & CABG
• CR promotes better quality, care management and limits avoidable adverse events
− CR has reduced emergency department, avoidable hospitalizations and long-term care utilization
• CR is a relatively low-cost intervention compared to inpatient treatments for acute cardiac conditions, and provides a high return on investment given the impact of its benefits
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PARTICIPANTSFOR SYSTEMS AND SOCIETY
FOR SYSTEMS& SOCIETY
FOR HOSPITALS/HEALTH SYSTEMS INFOGRAPHIC
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Importance of CR
PATIENT STORY
Steven Merchant
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PARTICIPANTSQUALITIES TO
CONSIDER
Cardiac Rehabilitation Champion
SKILLS Credible and influential with peers
Passion and interest in improving CR
Understanding of CR programs, structure and regulations
Action oriented
Experience with change management and improvement projects
Communication skills
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PARTICIPANTS
Cardiac Rehabilitation Champion (cont.)
ROLE Team Leader
Engages and collaborates with hospital leadership to obtain support for automatic referral with care coordination
Understands staff and patient needs, as well as management
Manages conflicting interests and scarce resources to get things done
Helps to build a culture to support change
Assists team in developing its Aim Statement and Action Plan
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PARTICIPANTS
Forming Your Multidisciplinary CR Implementation Team
CHOOSING TEAM MEMBERS
Decide who will be involved with implementing automatic referral and establishing effective care coordination.
Bring together individuals who represent all parts of the CR referral, enrollment and participation process
Plan for coordination across inpatient and outpatient settings by involving staff members from both
Include billing and insurance personnel
Include staff or patients (advisors) who can address the needs and concerns of patients
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PARTICIPANTS
Potential Multidisciplinary CR Team Members
CR Champion: leads the team and advocates for the initiative
Cardiac care clinicians: cardiologists, cardiac surgeons, physician assistants, or nurse practitioners provide input on treatment and referral
Cardiac Rehabilitation clinicians: nurses, physical therapists, exercise physiologists, physicians provide valuable perspectives on enrollment and participation
Cardiac care manager: provides important information about current workflows and potential areas for improvement
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PARTICIPANTS
Potential Multidisciplinary CR Team Members (cont.)
Information Technology (IT) staff: possess the skills necessary to enact the required changes for automatic referral and data collection. May include IT vendor representatives.
Quality improvement leaders (QI): provide insight into best practices for implementing and measuring quality improvement.
Patients: provide the end user perspective.
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PARTICIPANTS
Set the Stage for Change: Model for Improvement
MODEL FOR IMPROVEMENT
What are we trying to
accomplish?
How will we know that a change is an
improvement?
What change can we make
that will result in
improvement?
TAKEheart change/improvement = Automatic referral with effective care coordination
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Action Plan Components
PARTICIPANTS• Develop an Aim Statement Element
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Element 2
• Determine how to assess or measure yourprogress
Element 3
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• Identify the tasks required to achieve the aim, who is responsible for each task and the timeframe for completing each task
PARTICIPANTS
Element 1: The Aim Statement
WHAT IS IT? Why create an aim statement?
Acts as your beacon to guide and focus your team’s efforts
An aim statement answers: What are we trying to accomplish?
It is an explicit statement, crafted by the team, of the desired outcome of your improvement project
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PARTICIPANTS
TAKEheart Aim Statement
AIM STATEMENT Q: What do you hope to accomplish? A: Increase cardiac rehabilitation referrals, enrollment, and participation
Q: For whom? A: Patients with eligible diagnoses, e.g., MI, CABG, PCI
Q: Why is it important? A: Improves health, saves lives and reduces hospital readmissions
Q: What change will you implement to achieve your aim? A: Automatic referral with effective care coordination
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PARTICIPANTSGOALS
S.M.A.R.T. Goals
Specific: Description of a specific outcome or process
Measurable: How is it going to be measured, e.g., rate, frequency?
Achievable: Plan to stretch but make sure it is achievable
Relevant: Need to link directly to the Aim statement
Time bound: Need clear start and finish dates
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PARTICIPANTSEXAMPLE
A TAKEheart Aim Statement Example
We aim to increase the number of patients with MI, PCI and CABG who are referred, enrolled and participate in cardiac rehabilitation by 30%. This is important because we want to improve patient care and outcomes and reduce hospital readmissions. We will accomplish this aim by implementing automatic referral with care coordination by March 31,2022. We intend to see a 30% increase in current participation rates by December 31, 2022.
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PARTICIPANTSData Tracking for Quality Improvement
Element 2: Measure Progress
Tracking data as part of TAKEheart supports quality improvement
Increasingly, CR metrics (referral, enrollment, adherence rates; time to refer, etc.) are being incorporated into quality performance programs and can drive reimbursement
Reporting performance and quality metrics promotes health systems’ ability to work in a value-based, risk-taking environment, increasingly prevalent among payers.
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Assess Your Progress
MEASUREMENT
INCLUDE BOTH SHORT TERM AND LONG-TERM
ASSESSMENTS.
DEVELOP SPECIFIC OUTCOME AND
PROCESS MEASURES.
SET SPECIFIC GOALS THAT ARE NUMERIC AND MEASURABLE.
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PARTICIPANTS
Examples
S.M.A.R.T. GOALS
The percentage of eligible patients referred to cardiac rehabilitation will increase by 10% from Q1 to Q3.
The percentage of referred patients who enroll in a CR program will increase by 5% from Q1 to Q2.
The percentage of enrolled patients who complete a CR program will increase by 15% from Q2 to Q4.
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PARTICIPANTSIDENTIFY ACTION PLAN
COMPONENTS
Element 3: Tasks, Responsibilities & Timeframes
What tasks does your hospital need to undertake to implement automatic referral?
What tasks does your hospital need to undertake to establish effective care coordination?
Who will lead each task?
When will each task be completed?
Consider resource needs and priorities
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PARTICIPANTS
Utilize an Action Plan Template
TEMPLATE
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PARTICIPANTS
Tasks Need S.M.A.R.T. Goals Too
TASK: DEVELOP AUTOMATIC REFERRAL SPECS
Beginning 6/4/2021, the CR QI team will meet with IT representatives each Tuesday and Thursday at noon for a half hour to define the changes necessary for automatic referral and will complete the task by 7/28/2021.
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PARTICIPANTSCR WORKFLOW PROCESSES
Q & A
Our panelists are ready for your questions
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PARTICIPANTS
What’s Next?
PH PAGS
Continue working with your CR Team to write your aim statement and identify initial tasks for the action plan
Discuss your progress and challenges with other hospitals in the group
Exchange ideas and seek feedback from other hospitals on your aim statement in your PH PAG
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PARTICIPANTSCR WORKFLOW PROCESSES
Module 3
Understanding your Workflow Processes to Prepare for Systems Change
June 24, 2021, 3pm – 4pm ET
Module 3 Registration Link: https://abtassociates.webex.com/abtassociates/onstage/g.php?MTID=edf1661d4baa f841333b9583f827f2bfd
“Automating bad processes does not improve anything…our experience is that it is best to fix the process, then automate the fixed process.” Dr. John Halamka, CIO BIDMC, Boston, MA
Help us help you! Please answer the survey questions as you leave the event today
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