Continuing Care Quality Management: Right Care, Right Time, Right Place Applied to Skilled Nursing Facility Care

Abstracts from the Kaiser Permanente2018 National Quality Conference


Peter Khang, MD; Jennifer Cortez; Christine Jordan; Artem Aghourian

From Southern California

Background: The postacute care marketplace is segmented with high degrees of variability among skilled nursing facility (SNF) leadership, care quality, and outcomes. Appropriate and adequate governance of the care provided and oversight of our members in SNF ensure the care they receive is consistent with what they received in the hospital.
Methods: Population: Improving the quality outcomes and utilization of skilled nursing care for members (most often age 65 years and older). Intervention: Implement the Continuing Care Quality Management (CCQM) model. Comparison: Compare results with historical outcomes and utilization. Outcome Measures: SNF patient day rate (PDR), SNF discharge rate, length of stay, and readmissions.
Results: The primary metric for success has been the SNF PDR—measuring the number of skilled days per 1000 members. Between 2015 and 2017, we saw the SNF PDR drop by nearly 33%. SNF PDR is the product of volume of SNF admissions and the length of stay. We have seen our SNF admission volumes decrease as CCQM emphasizes appropriateness of SNF placement, and CCQM-Inpatient Quality Management (IQM) teams work together to send patients home with adequate resources. The average length of stay remained constant, and the SNF Healthcare Effectiveness Data and Information Set (HEDIS) 30-day readmission observed/expected ratio has been relatively stable, despite a 12% increase in the expected rate since 2016.
Discussion: The CCQM model translates Care Without Delay (CWD) to the continuum. It enhances the quality, timeliness and appropriateness of care for members, working relationships (internal and external), and business outcomes. Successful implementation of the model requires engagement of local and regional executive leadership, with a strong oversight component. Interdependent collaboration between IQM/CWD and CCQM is critical to making significant progress, as introducing the model will be the start of a culture change for both hospitalists and SNF specialists.

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