Leveraging the Value of Midas+ DataVision Toolpacks Brenda Pettyjohn RN, CPHQ Midas+ DataVision Clinical Consultant
Objectives Identify at least 1-2 uses for each of the Toolpacks Identify populations at high risk for readmissions Identify trends of preventable adverse outcomes 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 2
Wouldn t it be nice if analyzing data could be so easy? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 3
You need to have some tools available 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 4
Definition of Tool Part of Speech: noun Definition: instrument used to shape, form, finish Synonyms: apparatus, appliance, contraption, contrivance, device, engine, gadget, gizmo, implement, job, machine, means, mechanism, utensil, weapon, whatchamacallit 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 5
DataVision Toolpacks Assist with In-depth analysis Identification of trends Identification of opportunities for improvement (OFI) Three different types of Toolpacks Report Toolpack Readmission Toolpack Risk Management Toolpack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 6
DataVision Report Toolpack The first tool in your analysis tool box Personal favorite First step in detailed data analysis 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 7
Where Do I Find It? Choose the desired measure in the DataVision Navigator then click on the Report Toolpack icon on the right 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 8
The Report Toolpack generates a Microsoft Excel workbook with several worksheets that help you assess the population of interest. Utilization Top DRG Top Principal Diagnosis Top Principal Procedures Weekdays Admit and Discharge Time Discharge Status Complications of Care Major Complication Detail Attending Provider Utilization APR DRG Severity by Attending APR DRG Mortality by Attending LOS Outliers Payer Excel II Data 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 9
Reporting Considerations Identify the population of interest by considering: High volume, high cost, or high risk populations at your hospital Populations being case-managed at your hospital Potential populations for case management Key service or product lines at your hospital Specialty areas of key provider stakeholders Populations of interest by national quality initiatives, such as CMS, Joint Commission, IHI, and National Quality Forum Top five populations identified in DataVision Readmission Toolpack for all acute care admissions 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 10
The Excel II Data worksheet contains the data fields that are used to create the pivot tables in the Report Toolpack. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 11
Readmission Toolpack Assists in analysis of a current hot topic How the Toolpack works can be confusing DataVision Indicators and the Readmission Toolpack provide forward look 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 12
Where Do I Find It? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 13
Purposes of Readmission Rates Evaluate care management efficiency over time Identify potential system-wide quality improvement opportunities Identify specific patients amenable to clinical and community-based case management services Identify areas where Peer Review could educate individual providers Inclusion in physician profiles Measure the safe management of the population over time and across settings Pay for performance (public/internal incentives) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 14
Underlying Assumptions Readmissions are proxy measures for quality of care Not all readmissions are undesirable Not all readmissions are preventable Some readmissions can be influenced by proper medical management, discharge planning, and continuity of care The ultimate purpose of readmission rates is to help you identify the patients and conditions for which you can most likely make a difference 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 15
Key Points Readmission measures are reported in pairs The events that might have precipitated the readmission encounter (#2) likely occurred in the index (#1) encounter An example would be a patient with a principal diagnosis of Pneumonia was discharged 12/4/2011 and readmitted 12/6/2011 with a principal diagnosis of Sepsis. An index encounter can also be a readmission encounter (#1 and #2) A patient is discharged 6/1/2011 (#1) and is readmitted 6/4/2011 (#2), but also returns 7/3/2011 (#2) after discharge from 6/4/2011 encounter. That makes the 6/4/2011 encounter #1 and #2. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 16
More Key Points The index (#1) encounter qualifies for a measure based on its discharge date The readmission (#2) encounter qualifies for a measure based on its admission date The readmission encounter does not require a discharge date an active (nondischarged) encounter qualifies as a readmission 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 17
Key Points Continued Indicator Profile, GraphsDetail Profile, Indicator Graphs, and DataVision Report Toolpack display the index (#1) encounter that has a qualifying readmission encounter, not the readmission encounter (#2) itself The index encounter (#1) qualifies in the month that it was discharged An index encounter discharged 10/30/10 with a readmission encounter admitted 11/6/10 is displayed in the October column of the Indicator/Detail Profile and Indicator 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 18
A Picture to Assist in Understanding Midas+ Readmission Measures Readmission pairs are listed below, labeled A through D on the right For each pair, the encounter displayed in the numerator of the readmission measure is the index (#1) encounter This can become confusing when the index encounter also qualifies as a readmission encounter. Encounter #6 (5/19 5/23) is an example. It is the readmission encounter for #5 (encounter pair C) It is also the index encounter for #7 (encounter pair D) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 19
Define your index population Principal ICD-9 Diagnosis or Procedure codes The most clinically homogenous group that reflects the primary reason for the patient s admission Federal DRG Assignments Useful when focus of interest is on financial performance because reimbursement will match the defined population MDC Classification It s a big net to cast, but might be useful when examining performance of particular service or product lines within the hospital APR DRG codes Useful when the population of interest is well understood by stakeholders, and more granular data is required for various subgroups 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 20
A Caution When Choosing an Index Population Do not choose the numerator of a readmission measure, as this will give you the readmissions of your readmissions An example would be CDB:098N 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 21
Identify Qualifying Conditions for Readmission Event Same diagnosis only Gives false low values Not good for quality, case finding, or Peer Review Use with extreme caution if at all! Selected conditions only Probably best for physician profiling Difficult to get consensus on which conditions apply, therefore lacks comparison data All cause diagnoses Best for quality improvement, case finding, and Peer Review because it enables you to see cases that returned for changes in condition due to poor medical diagnostic work, failures in transition planning, or trajectory of disease Best for national comparison and benchmarking because it reflects whole system variables Can produce false positives, for example, patients readmitted for no related reason 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 22
Benefits of All Cause Readmissions Enables you to identify unexpected readmission causes that might be amenable to quality improvement or peer review Examples: CHF patients readmitted with pneumonia might have been misdiagnosed during the index admission Pediatric asthma patients readmitted with clostridium difficile might have been exposed at hospital Stroke patients readmitted with hip fractures might have been discharged without adequate home assessment to prevent falls Total Knee patients readmitted with sepsis might have been exposed to MRSA while in hospital 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 23
Facility-specific Readmissions Include readmits to same facility only Best for national comparison data and benchmarking Best for peer review and physician profiling Include readmits to any facility on your server Only available to Midas+ clients with multiple facilities in their database Useful when facilities are geographically within the same community Ideal for case management, case finding, and service utilization across a healthcare system within a single community 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 24
Performance Reporting Considerations Monthly time intervals Useful for populations with seasonal variations Useful for academic teaching facilities where resident cycles affect outcomes Best for examining variation over time (statistical process control) Quarterly time intervals Useful for reporting to key committees and boards Semiannual and annual intervals Useful for physician profiling (numbers are higher and therefore more meaningful) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 25
Last But Not Least The Risk Management Toolpack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 26
Where Do I Find It? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 27
What is the Risk Management Toolpack Standard report that produces an Excel workbook with volume and location of risk events by: Risk event type Risk event class View reports by: Clinical population (for example, Pneumonia patients) Time of day Day of the week MDC DRG ICD-9 diagnosis Nonpatient events Risk parameters Outcomes Significance Days between admission and event Days from event to report 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 28
What can the Risk Management Toolpack do for me? Allows Risk Manager and Analysts to see areas of interest in one report Assists with a proactive focus for a particular unit, department or population Shares this information with stakeholders in those areas Supports the prioritization of quality improvement work and decision making Uses the detailed data provided for each risk event to help focus on which events may require additional review, rather than reviewing the medical records for an entire group 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 29
Risk Management Toolpack Advantages (continued) Determines timeliness of reports Allows review of targeted outcomes or significance Assists in understanding the population at greatest risk within a Risk class or type All of the above combine to save time and resources 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 30
Quick Start Guides Resources Clients Only Website>Support>DataVision Documentation>Quick Start Guides elearning on the Clients Only Website Clients Only Website>Webinars/Education>DataVision DataVisionary Use Groups Held every other month usually the 2 nd week of the month via WebEx Live help from Midas+ Staff Submit support log Contact Brenda, Vanessa, or Barb 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 31
How do these really work? Barb will now walk you through each of the Toolpacks 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 32
Leveraging the Value of Midas+ DataVision Toolpacks - Part 2 Barbara Schork Midas+ DataVision Product Specialist
Where to Start Pneumonia is one of three key clinical topics tied to reimbursement (along with AMI & CHF). Pneumonia patients are especially prone to readmissions and comorbid conditions. We know this is a particularly problematic population for us. What process changes might we make to improve outcomes and reduce readmissions? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 2
Examining the Pneumonia Population High volume 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 3
ALOS as high as 95 th percentile 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 4
High Pneumonia mortality 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 5
30-day readmits in 95 th percentile 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 6
Average costs for MS-DRG 193, 194, and 195 above the median 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 7
Taking a Deeper Dive into the Data Let s start with the DataVision Report Toolpack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 8
What Issues Do We See? 54% 3-7 days (O Zone) 18% 1-2 days (U Zone) 28% >7 days (Q Zone) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 9
Top Principal Diagnoses Is there an opportunity to improve clinical documentation? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 10
Admissions by Day of Week One in four patients is admitted on Saturday or Sunday, when physician access may be limited. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 11
Admissions by Time of Day More than half of PN patients are admitted between1200 and 2100 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 12
Major Complications of Care 302/755 (40%) had 1+ Dx Not Present on Admission 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 13
Other Complications of Care Most frequent other NPOA complications of care include: Hypopotassemia Obstructive Chronic Bronchitis (OCB) with acute exacerbation Disorders of phosphorus metabolism Constipation NOS Anemia NOS 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 14
LOS Outliers Patients with LOS >2 SD from your hospital s ALOS are most likely to have adverse events. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 15
Mortalities Our hospital has been above the median in mortalities for 10 of the last 11 quarters. The Report Toolpack might show us some patterns in this sub-population. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 16
Discharge Disposition 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 17
Areas for Further Investigation 25 of the 38 mortalities had a LOS of >7 days Average LOS was 12, but expected LOS was only 8 29 had a principal diagnosis of Pneumonia NOS One patient who expired had a mortality risk of 2 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 18
Let s Look at Readmissions We already know our 30-day readmissions are noticeably higher than the median. The Readmission Toolpack will let us take a more in-depth look at the characteristics of our PN readmits. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 19
Looking at PN Readmission Detail For this example, we have selected 30-day, nonelective readmissions for our PN population. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 20
Days Between DC and Readmit Nearly 2/3 of patients who were readmitted within 30 days came back within the first two weeks, and just over half of those were readmitted within the first week post-discharge. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 21
Principal Readmission Diagnosis Examine diagnoses to identify complications of care that might have contributed to the readmission. Most common reasons for readmission were pneumonia (22%), OCB (15%), acute respiratory failure (7%) and septicemia (7%). 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 22
Readmit by Provider 3 attendings have both a relatively high volume of cases and a high readmission rate even higher than the hospital average A similar pattern exists for the top 2 procedure providers 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 23
Analyzing Readmits by Provider Group 1. Create a ReporTrack report with provider names and practice groups, and then export it to an Excel file. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 24
2. Create a new worksheet in the Readmission Toolpack output file, and then copy and paste the provider list you exported. Remember to include both active and deactivated providers you are dealing with historical data. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 25
3. Add a column to the index and readmission encounter worksheets, and then use the Excel VLOOKUP function to populate the column with the provider practice groups. =VLOOKUP(AI10, Providers'!A2:B806,2) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 26
4. Create or modify Excel pivot tables to organize the data by practice group. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 27
Other Applications for Practice Group Data Core measure performance by practice group can be compared with readmissions for that practice group for a given clinical topic: 1. Run core measure results by provider look at overall performance, OFIs 2. Use VLOOKUP to associate providers with practice groups 3. Use pivot tables to organize results You can crosstab any of the pivot tables in the DataVision Readmission Toolpack by adding the criterion of practice group. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 28
Perhaps Risk Events Were a Contributing Factor Historically, respiratory patients account for the most falls in our hospital, so let s start there. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 29
Let s Look at Falls in the MDC 4 Category Add DRG MDC No. to the Pivot Table Report Filter and filter on MDC 4 (Respiratory) 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 30
Bedside Falls Occur Most Often 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 31
Falls by Location MDC 4 Three units account for the vast majority of falls 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 32
Falls by Risk Parameters MDC 4 Bedside falls occurred most often when the bed position was down or in locked position. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 33
Falls Peak in the Early Morning and Again at 0900 What activities are typically taking place at peak fall times? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 34
Most Falls Occur on Tuesdays 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 35
Most Falls Occur 2-6 Days After Admit 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 36
Let s Move on to Med Errors Pneumonia patients are likely candidates for med errors because of the complexity of their care 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 37
Extra/Improper/Missed Dose Most Common 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 38
Med Errors by Location Two units account for >50% of events 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 39
>50% of Med Errors Occur Friday-Sunday 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 40
Med Errors Peak Early in the Encounter 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 41
Where to Go From Here Examine admit and discharge practices to optimize LOS Review documentation practices Look at staffing levels and staffing mix by time of day and day of week Examine communication between departments and shifts Review falls prevention and medication reconciliation processes???? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 42
Thank you for attending. Questions, anyone? Brenda Pettyjohn, RN, CPHQ Midas+ DataVision Clinical Consultant brenda.pettyjohn@acs-inc.com Barbara Schork Midas+ DataVision Product Specialist barbara.schork@acs-inc.com