Continuing Care Quality Management: Practice, Performance, Proof


Peter Khang, MD, MPH, FAAFP; Jennifer Cortez;
Christine Jordan, LCSW; Artem Aghourian, MBA

Abstracts from the Kaiser Permanente 2019 National Quality Conference

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 SNFs, ensures they receive care that is consistent with what they received in the hospital.
Methods: Continuing Care Quality Management (CCQM) aims to improve the quality outcomes and utilization of skilled nursing care for members in SNFs or to those considered for it (most often Medicare/65+ members). To do so the Kaiser Permanente Southern California Region implemented CCQM, which emphasizes appropriate and timely care for members in SNFs and ensures the appropriateness of SNF placements from the hospital. We compared our results with historic outcomes and utilization, and other utilization trends in the organization. To track our outcomes, we measured SNF patient day rate, SNF discharge rate, average lengths of stay, and 30-day readmissions (posthospital and post-SNF discharge).
Results: The primary metric for success has been the SNF patient day rate—measuring the number of skilled days per 1000 members. During the course of nearly 3 years (2015-2018), we have seen the SNF patient day rate drop by nearly 33%. This metric is comprised of the volume of members entering a SNF and the length of stay. As CCQM and Inpatient Quality Management work together to send patients home when possible, our volume of SNF members has decreased, while our average length of stay remained the same. We have observed a modest decrease in the Healthcare Effectiveness Data and Information Set readmission observed/expected ratio, despite a 12% increase in the expected rate in the 2 years; and a significant reduction in our 30-day post-SNF readmission rate.
Discussion: The CCQM model enhances the timeliness and appropriateness of care for members, improves working relationships (internal and external), and produces patient satisfaction and business outcomes. Throughout the implementation process the Southern California Region has been able to identify multiple practices that help drive CCQM performance for various medical centers. Understanding those practices, why they are important, and what impact might be expected supports other Regions in the implementation as well.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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