Cindy Sun, MSN, RN, COS C Crystal Welch, MSN, RN Misty Kevech, MSN, RN, COS C Describe the overarching purpose of both HHQI and the Million Hearts initiative Identify three (3) key tools from either of the two (2) Cardiovascular Health Best Practice Intervention Packages (BPIPs) that may be appropriate for your agency Develop two (2) new methods of education to integrate cardiovascular health into your practices 1
Goal: Improve the quality of care home health patients receive Special Project funded by Centers for Medicare & Medicaid Services Free evidence based tools and resource Many networking opportunities with 11,000 participants Focusing on quality of home health care measured by : Reduction of avoidable ACH Improvement in oral medication i management Improvement of immunization rates Improvement of cardiovascular health Continuing HH focus, but all care settings and patients participate Introducing Underserved Population Network (UP) Launch of the Home Health Cardiovascular Data Registry 2
Cardiovascular Health Reducing Hospitalizations Chronic Diseases, Falls Prevention & Wound Care Reducing Disparities 3
Home Health is returning to QIO Core Work after 6 year absence QINs QIOs will be working with limited number of HHAs in each state on the following: HHQI evidence based practices Cardiovascular health Quality improvement Contact your QIN QIO immediately Launched 2011 Co Leaders: CDC & CMS All settings Goal: Prevent 1 million heart attacks and strokes by 2017 Million Hearts The Million Hearts word and logo marks, and the Be One in a Million Hearts slogan and logo marks and associated trade dress are owned by the U.S. Department of Health and Human Services (HHS). Use of these marks does not imply endorsement by HHS. Use of the Marks also does not necessarily imply that the materials have been reviewed or approved by HHS. 4
Heart Disease is #1 cause of death Stroke is #4 cause of death 1 out of 3 deaths related to CVD Greatest contributor to racial disparity in life expectancy George, Tong, Sonnernfeld, & Hong, 2012; Roger VL, et al. Circulation. 2012;125:e2 e220. & Heidenriech PA, et al. Circulation. 2011;123:933 4 5
HHQI CV Health Improvement Initiative 6
HHQI Cardiovascular Resources HHQI National Campaign Website 7
HHQI National Campaign Website BPIPs on HHQI Website 8
Risk Factors: Heart Attack Risk Factors: Stroke Age Age Diabetes High blood pressure Elevated total cholesterol Diabetes Elevated high density lipoprotein Tobacco or alcohol use cholesterol levels Hx of cardiovascular disease High Blood Pressure Overweight/obesity, physical Tobacco use inactivity Diet, obesity, physical inactivity Hx of TIAs or Sickle Cell Alcohol use disease Heredity Heredity Gender & race AHRQ, 2002; CDC, 2009, Heart Disease Risk Factors; CDC, 2010, Risk Factors for Stroke; Right Diagnosis from healthgrades, 2013; and Erhardt,et al., 2013 9
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3 minute video by Mayo Clinic AHA s series of animated pictures with text on 15 different cardiac topics 11
SOURCE: National Vital Statistics System, US Census Bureau, 2008 2010. 12
BP Classification Hypertension Classification: Stages and Management (JNC 7 Express, 2003, p. 3) *Systolic BP, mm Hg *Diastolic BP, mm Hg Lifestyle Modification Initial Drug Therapy: Without Compelling indications** Initial Drug Therapy: With Compelling Indications Normal <120 and <80 Encourage No antihypertensive drug indicated Drug(s) for compelling indications Prehypertension 120 139 or 80 89 Yes No antihypertensive drug indicated Drug(s) for compelling indications Stage 1 hypertension 140 159 or 90 99 Yes Thiazide type diuretics for most; may consider ACEI; ARB, BB, CCB, or combination Drug(s) for compelling indications; Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed Stage 2 hypertension >160 or >100 Yes 2 drug combination for most*** (usually thiazide type diuretic Drug(s) for compelling indications; Other antihypertensive and ACEI or ARB or BB or CCB) drugs (diuretics, ACEI, ARB, BB, CCB) as needed ASH/ISH guidelines (Weber, et al, 2013), AHRQ, 2002; CDC, 2009, Heart Disease Risk Factors; CDC, 2010, Risk Factors for Stroke; Right Diagnosis from healthgrades, 2013; and Erhardt,et al., 2013 Recommended Lifestyle Modifications for Hypertension Management Lifestyle Modifications Weight Reduction Systolic BP reduction range (approximated) 5 20 mm Hg / 10 kg of weight loss Links to Patient Tools Aim for a Healthy Weight : Keep An Eye on Portion Size Aim for a Healthy Weight: Patient Booklet Adopt DASH eating plan 8 14 mm Hg At a glance: Lowering your Blood Pressure with DASH Your Guide to Lowering Your Blood Pressure Recommended Lifestyle Modifications with DASH for Dietary sodium reduction 2 8 mm Hg Where s the Sodium? Sodium Tip Sheet Hypertension Physical Activity 4 9 mm Hg Your Guide to Physical Activity and Your Heart Moderation of alcohol 2 4 mm Hg Fact Sheet Alcohol Use and Health STOP SMOKING for overall cardiovascular risk reduction Alcohol and Heart Disease 13
If every elevated systolic blood pressure was reduced by 5 mm Hg, results would include: 14% overall reduction in mortality due to stroke 9% reduction in mortality due to CHD 7% decrease in all cause mortality JNC 7 Complete, 2004 Accurate Blood Pressure Monitoring Steps for accuracy Video and article from New England Journal of Medicine BloodPressure Accuracy & Accurately Assessing Orthostatic Hypotension 14
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Ambulatory Blood Pressure Monitoring i Regular measurement of BP outside of clinical setting Example home monitors 16
Sample design Word document with sample text 17
Adults with diagnosed or undiagnosed: Hypertension Hypercholesterolemia Diabetes at least 1 of 3 45% 2 of 3 13% 3 of 3 3 of 3 3% 18
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Most important preventable cause of premature death in US Increases risk of developing many chronic disorders including atherosclerosis, leading to MI & stroke Controlling/ reversing atherosclerosis is an important to preventing future heart attacks and strokes AHA, 2012 21
Set a QUIT Date & sign a no smoking contract Choose a Decide if using method for medication quitting might help Mk Make a plan for Stop smoking on your QUIT Day your QUIT Day AHA, 2011 22
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Sample design Word document with sample text 24
Do you or insurance plan offer convenient cessation programs? How about your HHCAHPS? Do you ever receive complaints or request for nonsmokers? Is your organization considering a no smoking policy at the office? 25
BMI, Cholesterol, & BP monitoring Activity logs Lunchtime walks Zumba after work Running programs Biggest Loser Competitions Weight Watchers at Work Healthy snacks Food tips Recipe exchanges Office salad bar OLA ALA 26
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Jeopardy type games with facts on ABCS Competency Fairs Include activities to guess facts with prizes How many mm Hg reduction will reduce a person s mortality due to stroke by 14%? Contests Individuals or teams Name the risk factors for MI &/or Stroke Scenarios and discuss intervention strategies Including non adherent patient and physician scenarios Bulletin boards, quizzes, and podcast 28
Policies & Procedures State agency expectation of who and when are to assess BP Establish standardized protocols related to BPs and other ABCS Revise parameter standards (e.g., < 150/90 or less) Modify EHRs for easy access to trending vital signs Use standardized communication systems and tools (e.g., SBAR) Equipment Ensure all staff have access to accurately working equipment Accommodate for hearing impairments State agency expectations for routine cleaning, inspections, and testing Cardiovascular Prevention Culture Create a sense of urgency for integrating preventable CV health Select appropriate resources Use games, skits, etc. at staff meetings to convey importance Assign staff member to abstract and enter HHCDR data d hl d h l h ff Use PDSA cycles to assess and modify CV interventions (start small and build) Cardiovascular Review HHQI data monthly and share results with staff Health Data 29
Accurate Assessment Validate that each nurse has right size equipment Ensure BPs correctly sounds simple but not always done Assess vital sign trending each visit all disciplines Communicating with Physicians & Practitioners Ask for patient specific parameters or utilize agency standardize protocols Use standardized effective communication methods (e.g., SBAR) Lifestyle Modification Education Teach all lifestyle modifications often through out episode of care Acknowledge that these modifications will effect most chronic diseases Take BPs on all visits Obtain SN referral for further assessment and education, if needed Teach selfmanagement of medications to improve adherence PT OT SLP Establish home exercise program & provide safety education Provide postural syncope education, especially with bathing Teach self management of medications to improve adherence Evaluate, treat, and teach on swallowing issues with pills/fluids Teach cognitive skills to improve adherence to medications 30
Social Worker Build community resources Create food dbank klists Connect with local faith organizations HHA Educate on cardiac health including diet Check BP accuracy and parameters on care plans Teach s/s to report 31
Aligns with physician quality measures (PQRS) Includes patients with the following: Hypertension Ischemic Vascular Disease Dyslipidemia Tobacco use Cardiovascular Health Reducing Hospitalizations Chronic Diseases, Falls Prevention & Wound Care Reducing Disparities 32
1. Register for HHQI & Cardiovascular Health Data Registry www.homehealthquality.org Stay tuned for Phase 4 Kick Off Event info 2. Connect with your state QIN QIO or Network Coordinator QIN QIO see listing http://www.cms.gov/newsroom/mediareleasedatabase/pressreleases/2014 Press releases items/2014 07 18 07 18.html Network Coordinator listing http://www.homehealthquality.org/about Us/Partners/HHQI Network.aspx 3. Review the Cardiovascular Health BPIPs Begin with Aspirin and Blood Pressure Control Determine if BPs are being taken accurately and consistently 4. Connect with HHQI through Social Media Facebook, LinkedIn, Twittter, MY HHQI Blog, Live Chat www.homehealthquality.org 33
67 Contact Information: Cindy Sun csun@wvmi.org Misty Kevech mkevech@wvmi.org Crystal Welch cwelch@wvmi.org And of course, we can always be reached at HHQI@wvmi.org 34
HHQI This material was prepared by Quality Insights, the Quality Innovation Network Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication Number: 11SOW WV HH MMD 091514 35