Embrace New Culture in Postacute Care: Shaking up the Status Quo

Abstracts from the Kaiser Permanente2018 National Quality Conference


David Wong, MD; Karen Sirski-Martin, RN, MSN, CCRN, HACP;
Cora Bailey, RN, MSN, PHN, CLNC


From Southern California

Background: The Continuing Care Quality Management (CCQM) program models the Integrated Quality Management (IQM) philosophies, tools, and principles for continuing care services of Kaiser Permanente Southern California (KPSC) beginning with skilled nursing facility (SNF) partners. The CCQM model enhances systems for service and oversight and moves our organization’s goal of matching patients with the “Right Care, Right Place, and Right Time.” This results in improved quality of care by standardizing workflows and setting expectations with SNF partners.
Methods: Previously, SNFs were used as a discharge destination because they were the path of least resistance. Patients frequently did not meet the medical necessity for skilled level of care. Because of inappropriate admissions, a rise in length of stay (LOS) and varying workflows in the SNFs, the increased costs created a need for workflow standardization, collaboration, and robust oversight. Implementation of the CCQM model of care in the postacute setting, which was modeled after the IQM philosophies, tools, and principles, began in 2013. To measure performance, the following metrics were monitored: 1) SNF patient day rate (PDR), 2) average LOS (ALOS), 3) 30-day Healthcare Effectiveness Data and Information Set (HEDIS) readmission observed/expected (O/E), and 4) SNF discharge rate.
Results: After implementing CCQM in 2013, performance measures significantly decreased from the 2013 baseline through the current year: 1) SNF PDR for the Riverside Service Area (Central, West, and East markets) decreased 16.7 points and 26.1 points for Riverside Service Area (Coachella Valley market), 2) ALOS for the service area decreased 2.7 days, 3) 30-day HEDIS O/E for the service area increased slightly from 2016 to 2017 by 0.01; however, it decreased significantly from 2015 to 2016 by 0.08. 4) SNF discharge rate for the service area continues to decrease steadily: -0.7 points in 2016 and -0.5 points in 2017.
Discussion: The CCQM model of care enhanced the collaboration with IQM and SNF partners to adopt consistent workflows to increase efficiency and quality of services at the SNFs. Our primary learning was and continues to be the high turnover rate of SNF partners (leadership and staff). To ensure continuity, continual education and engagement on the CCQM model of care is needed. The next step is to spread the CCQM model to our nursing home partners to deliver the same standardized care to our long-term care patients.

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