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Senior Centered CareSenior Centered CareProgramming for Older AdultsProgramming for Older Adults
ExcellusAugust 13, 2009
Adult Volume (Seniors = 65+)Adult Volume (Seniors = 65+)
540520
505
580.3
254
304
354
404
454
504
554
604
654
704
Jan-
06Fe
b-06
Mar
-06
Apr
-06
May
-06
Jun-
06Ju
l-06
Aug
-06
Sep
-06
Oct
-06
Nov
-06
Dec
-06
Jan-
07Fe
b-07
Mar
-07
Apr
-07
May
-07
Jun-
07Ju
l-07
Aug
-07
Sep
-07
Oct
-07
Nov
-07
Dec
-07
Jan-
08Fe
b-08
Mar
-08
Apr
-08
May
-08
Jun-
08Ju
l-08
Aug
-08
Sep
-08
Oct
-08
Nov
-08
Dec
-08
Jan-
09Fe
b-09
Mar
-09
Apr
-09
May
-09
Jun-
09
Seni
or V
olum
e 65
+
Senior Volume 65+ UCL +2 Sigma +1 SigmaAverage -1 Sigma -2 Sigma LCLMean Volume Age 19-64 (Excluding Maternal/Child)
91.31
82.2784.93
59.89
69.89
79.89
89.89
99.89
109.89
119.89
Jan-
06Fe
b-06
Mar
-06
Apr
-06
May
-06
Jun-
06Ju
l-06
Aug
-06
Sep
-06
Oct
-06
Nov
-06
Dec
-06
Jan-
07Fe
b-07
Mar
-07
Apr
-07
May
-07
Jun-
07Ju
l-07
Aug
-07
Sep
-07
Oct
-07
Nov
-07
Dec
-07
Jan-
08Fe
b-08
Mar
-08
Apr
-08
May
-08
Jun-
08Ju
l-08
Aug
-08
Sep
-08
Oct
-08
Nov
-08
Dec
-08
Jan-
09Fe
b-09
Mar
-09
Apr
-09
May
-09
Jun-
09
Ave
rage
Dai
ly C
ensu
s
Avg Daily Census UCL +2 Sigma +1 SigmaAverage -1 Sigma -2 Sigma LCLMean Avg Daily Census Age 19-64 (Excluding Maternal/Child)
Adult Average Daily CensusAdult Average Daily Census
Length of StaySeniors 65+
5.51
4.404.21
3.50
4.00
4.50
5.00
5.50
6.00
6.50
Jan-
06Fe
b-06
Mar
-06
Apr
-06
May
-06
Jun-
06Ju
l-06
Aug
-06
Sep
-06
Oct
-06
Nov
-06
Dec
-06
Jan-
07Fe
b-07
Mar
-07
Apr
-07
May
-07
Jun-
07Ju
l-07
Aug
-07
Sep
-07
Oct
-07
Nov
-07
Dec
-07
Jan-
08Fe
b-08
Mar
-08
Apr
-08
May
-08
Jun-
08Ju
l-08
Aug
-08
Sep
-08
Oct
-08
Nov
-08
Dec
-08
Jan-
09Fe
b-09
Mar
-09
Apr
-09
May
-09
Jun-
09
Leng
th o
f Sta
y D
ays
LOS Age 65+ UCL +2 Sigma +1 SigmaAverage -1 Sigma -2 Sigma LCLMean LOS Age 19-64 (Excluding Maternal/Child)
Senior Services Senior Services Programming and IntegrationProgramming and Integration
Complication PreventionMaintaining Function Care Transitions
To assess and improve the interdisciplinary, comprehensive processes of care for seniors
using the Crouse Hospital care network, paying particular attention to geriatric syndromes and other
issues unique to seniors accessing healthcare.
Care TransitionsCare Transitions Goal – Improve the patient’s ability to
self manage chronic conditions Global Outcomes
Reduce readmissions Enhance patient satisfaction/loyalty Ready Crouse for healthcare reform
Eric Coleman, MD University of Colorado
Why do patients return to the hospital?Why do patients return to the hospital?Medication issues Medication record &
discrepancy analysis
Lack of timely follow up with MD/NP
Follow up appointment
Lack of knowledge/mgt of chronic conditions
Red flags & personal health record
Care Transitions ProcessCare Transitions Process Community-dwelling patients with
congestive heart failure / atrial fibrillation
Patient visited early in hospital admission
Home visit within 72 hours Phone calls on days 2, 7, 14, and 30
Reduce the 30 day readmission rate of CHF Reduce the 30 day readmission rate of CHF patients in the program to below 9.71% patients in the program to below 9.71%
(the hospital mean)(the hospital mean)Percentage of CHF Patients in Program Readmitted within 30 Days
1.79%2.62% 1.93%
9.71%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
10/1
5/20
07 (
n=0/
8)
10/3
1/20
07 (
n=1/
10)
11/1
5/20
07 (
n=1/
3)
11/3
0/20
07 (
n=0/
10)
12/1
5/20
07 (
n=0/
3)
12/3
1/20
07 (
n=0/
1)
1/15
/200
8 (n
=0/1
)
1/31
/200
8 (n
=0/6
)
2/15
/200
8 (n
=0/2
)
2/29
/200
8 (n
=0/6
)
3/15
/200
8 (n
=1/9
)
3/31
/200
8 (n
=0/6
)
4/15
/200
8 (n
=0/4
)
4/30
/200
8 (n
=0/5
)
5/15
/200
8 (n
=0/6
)
5/31
/200
8 (n
=0/7
)
6/15
/200
8 (n
=0/2
)
6/30
/200
8 (n
=0/5
)
7/15
/200
8 (n
=1/1
2)
7/31
/200
8 (n
=0/5
)
8/15
/200
8 (n
=0/3
)
8/31
/200
8 (n
=0/3
)
9/15
/200
8 (n
=0/3
)
9/30
/200
8 (n
=0/3
)
10/1
5/20
09 (
n=0/
7)
10/3
1/20
09 (
n=1/
8)
11/1
5/20
09 (
n=0/
6)
11/3
0/20
09 (
n=0/
6)
12/1
5/20
09 (
n=0/
3)
12/3
1/20
09 (
n=0/
3)
1/15
/200
9 (n
=1/7
)
1/31
/200
9 (n
=0/7
)
2/15
/200
9 (n
=0/4
)
2/28
/200
9 (n
=0/3
)
% o
f Rea
dmis
sion
s
Percent UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL Goal
Care Transitions - Medication Discrepancies
3.73
5.17
0
2
4
6
8
10
12
14
16
10/1
5/20
0710
/31/
2007
11/1
5/20
0711
/30/
2007
12/1
5/20
0712
/31/
2007
1/15
/200
81/
31/2
008
2/15
/200
82/
29/2
008
3/15
/200
83/
31/2
008
4/15
/200
84/
30/2
008
5/15
/200
85/
31/2
008
6/15
/200
86/
30/2
008
7/15
/200
87/
31/2
008
8/15
/200
88/
31/2
008
9/15
/200
89/
30/2
008
10/1
5/20
0910
/31/
2009
11/1
5/20
0911
/30/
2009
12/1
5/20
0912
/31/
2009
1/15
/200
91/
31/2
009
2/15
/200
92/
28/2
009
3/15
/200
93/
30/2
009
4/15
/200
94/
30/2
009
5/15
/200
95/
31/2
009
# of
Med
Dis
crep
anci
es
Med Discrepancies UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL
Patient Satisfaction with the Care Transitions ProgramQuestion: "I was very satisfied with the Care Transitions Program"
3.63
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
10/1
5/20
07
10/3
1/20
07
11/1
5/20
07
11/3
0/20
07
12/3
1/20
07
1/15
/200
8
1/31
/200
8
2/15
/200
8
2/29
/200
8
3/15
/200
8
3/31
/200
8
4/15
/200
8
4/30
/200
8
5/15
/200
8
5/31
/200
8
6/15
/200
8
6/30
/200
8
7/15
/200
8
7/31
/200
8
8/15
/200
8
8/31
/200
8
9/15
/200
8
9/30
/200
8
10/3
1/20
09
11/3
0/20
09
12/3
1/20
09
1/31
/200
9
2/28
/200
9
3/30
/200
9
4/30
/200
9
5/31
/200
9
Patie
nt S
atis
fact
ion
Scor
e
Patient Satisfaction UCL +2 Sigma +1 Sigma Average -1 Sigma -2 Sigma LCL
Resource UtilizationResource Utilization
285 encounters Average # admits = 2.85 Total cost = $1,958,197
100 CHF/Afib patients examined 1/2007 – 9/2008
All inpatient and outpatient visits related to CHF or Afib
Financial ImpactFinancial Impact(1/2007 – 9/2008)(1/2007 – 9/2008)
100 patients studiedPatients stayed out of hospital
70
Patients with subsequent admissions
30
*Admissions any time in study periodED & inpatient visits
Patients with Multiple Visits Patients with Multiple Visits Before InterventionBefore Intervention
45 patientsPatients stayed out of hospital
26
Patients having subsequent admissions
19
*Admissions any time 1/2007 – 9/2008ED & inpatient visits
Patients with Multiple Visits Patients with Multiple Visits Before InterventionBefore Intervention
19 Patients w Subsequent Admissions
Before AfterAvg # visits = 3.4 Avg # visits = 1.7
ALOS = 4.8 ALOS = 3.9
*Admissions any time 1/2007 – 9/2008ED & inpatient visits
Days to ReadmissionDays to Readmission26 Patients with Multiple Admissions
before CT Intervention & no readmits after intervention
Avg. days to rehospitalization before intervention = 86
Avg. days out of hospital after intervention = 175
Patients Enrolled Patients Enrolled During First CHF AdmissionDuring First CHF Admission
55 PatientsPatients stayed out of hospital
44
Subsequent admissions
11
*Admissions any time 1/2007 – 9/2008ED & inpatient visits
Patients Enrolled Patients Enrolled During First CHF AdmissionDuring First CHF AdmissionN= 55 / 11 with Subsequent Admissions*
Before AfterAvg # visits = 1.0
Avg # visits = 1.5
ALOS = 6.0 ALOS = 4.2
*Admissions any time 1/2007 – 9/2008ED & inpatient visits
Sharing Our SuccessSharing Our SuccessUniversity of Rochester
BassettThompson Health
Healthcare Advisory Board Cardiovascular RoundtableHealth Quest, Poughkeepsie, NY
Glens Falls HospitalBronson Hospital, Kalamazoo, MI
Christiana CareOcean Medical Center, NJ
Wheaton Franciscan HealthcareAlegent Health/Immanuel Health Systems
OSF FranciscanMorton Plant Mease Health CareSt. Francis Hospital, Tulsa, OK
Sharing Our SuccessSharing Our SuccessAmerican Hospital Association
Wall Street JournalHANYS Annual meeting
Dept of Health -- Patient Centered Care Northeast Home Care Nurses Association
American Heart Association Regional meetingIPRO Teleconference
HC Pro Teleconference
What’s Next?What’s Next? Complex elders with multiple
comorbidities Transitional Care – Mary Naylor, PhD,
RN University of Pennsylvania COPD, frequent ED visitors, diabetes
– good possible populations