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Progressing Together: The Next Phase of HHQI


Shanen Wright: Hello, and welcome to Progressing Together, the next phase of the Home Health Quality Improvement National Campaign.  We’re so happy that so many of you have joined us today to learn more about this new, exciting phase of HHQI and everything that we will have to offer.  During today’s presentation we’ll first of all provide an overview of the EDNA Learning and Action Network and the resources available to all of the participants in the campaign.  This will be followed by presentations about our key Phase 4 enhancements, including the new HHQI CardioLAN, HHQI University educational resources, video Best Practice Intervention Packages, and then we’ll conclude with questions and answers and next steps.  Now without further ado, it is my great pleasure to introduce today’s keynote speaker for our welcome, who is Cynthia Pamon.  Cynthia?

Cynthia Pamon: Hello everyone, thank you for joining the webinar today.  On behalf of the leadership team and staff here at the Centers for Medicare & Medicate Services we welcome you and hope that you find Phase 4 of the Home Health Quality Improvement National Initiative of value to your organization and most importantly to your patients.  As you will hear today, we will continue to build upon past successes while introducing new work.  Considering time constraints and a multitude of other day-to-day issues, I truly appreciate you for working with us.  This work was designed for your agencies and patients, and continues to improve and evolve due to your hard work and feedback.  Success of it truly depends on you and our ability to assist you with improving the care that our home care patients receive.  I look forward to more success in the months to come, and that said I will now turn it back over to Shanen Wright.  Shanen?

Shanen Wright: Thank you so much Cynthia.  We really appreciate your welcome and all your support of HHQI throughout the years.  Now as we mentioned, I’d like to provide just a brief overview of the campaign.  I know many of you joining us on today’s webinar are experienced campaign participants who may have been with us since our launch in 2007.  But we’re also bringing many new home help and call setting providers into the campaign for our fourth phase, so we wanted to provide a high level overview of what it is that the campaign has to offer before we jump into some of the key Phase 4 enhancements.

So for those of you new to HHQI, everything we provide is absolutely free and is available at homehealthquality.org, and really can be put into four categories consisting of education, data, networking, and assistance.  I’ll take a moment to tell you a little more about each of the variants.  The cornerstone of our educational resources center on what are called Best Practice Intervention Packages or BPIPs.  These resources are all evidence based, created by the HHQI National Campaign Team, and vetted by technical expert panels from all over the country of experts in various topics related to improving home health quality.  These packages are targeted to various clinicians within the home health setting and call setting as well.
There are many applicable resources to these best practice intervention packages.  There are a wealth of archived BPIPs that are available right now at homehealthquality.org on topics like reducing avoidable acute care hospitalizations, improving oral medication management, falls prevention, and many other topics relevant to improving home health quality.  These packages are not only just as a PDF document on the website, they also include a recorded webinar, a podcast or audio recording, and links to more information for folks who want to learn more about the topic at hand.

A little later in today’s presentation Crystal Welch will be by to tell you about our latest innovation with Best Practice Intervention Packages, which will be video BPIPs.  We’ll further expand the multimedia platform of educational offerings by the Home Health Quality Improvement National Campaign.  So that’s the E in EDNA, education.

We next move to the D, for data.  The National Campaign offers individualized reports for any CMS certified home health agency in the United States that includes rates of a acute care hospitalization, oral medication management, and immunization.  These are updated on a monthly basis and securely delivered online through our data access system.  Now for these data reports, the acute care hospitalization, medication and immunization, these are based on OASIS data, both raw and risk adjusted.  We also offer historical trends and target setting as tools within the data resources, so that you can go back and see how your agency is performing over time.  Even if you have not yet signed up for data access, you will have access to your historical reports that are OASIS based.

In addition to this OASIS based reports, we’re looking forward to the launch of the Home Health Cardiovascular Data Registry on November 15th nationwide.  This registry had a very successful pilot phase in Phase 3 of the HHQI National Campaign, and now will be expanding nationwide to allow home health agencies to transmit their data and receive reports on how they’re progressing at preventing heart attacks and strokes.  Now this Home Health Cardiovascular Data Registry is in support of the Home Health Cardiovascular Improvement Initiative that HHQI piloted in its third phase.  This improvement initiative aligns with the national Million Hearts initiative that many of you are likely familiar with, and focuses on the ABCS of preventive cardiovascular care.  As you see from the graphic on your screen, the ABCS stand for aspirin as appropriate, blood pressure control, cholesterol management, and smoking cessation.  Cindy Sun will be by here a little bit later in the presentation to tell you a lot more details about the Home Health Cardiovascular Improvement Initiative and the Cardiovascular Data Registry.

This brings us to the N in EDNA, which stands for networking.  The HHQI National Campaign has a wide array of networking resources to help you connect with other agencies, stakeholders, and the people who can make a difference in improving home health quality.  There are both virtual and grassroots networking opportunities through the National Campaign.  In the virtual sphere we have a whole array of social media resources that will be launching soon, including a Facebook page, YouTube videos with an HHQI channel, Twitter feed, LinkedIn and more.

Also as an online sharing resource, we host monthly live chats which are opportunities to interact online with the HHQI National Campaign and thousands of home health agencies across the country.  We do those every month, and invite you to join us for our first one which will be taking place in November and will continue for the next several months.  Now aside from just the virtual networking opportunities, we also have a confederation of more than a hundred HHQI network coordinators, who are individuals and groups that have regular contact with multiple home health agencies.  These folks are here to help you get the resources you need, encourage your participation in HHQI, and to make connections all geared at improving home health quality.

One of the key enhancements that we will continue to talk about throughout today’s presentation is the inclusion of the home health setting in the 11th Statement Of Work For Quality Innovation Network Quality Improvement Organization, or QINQIO.  This is a return to the setting after about 6 years of an absence, and you see here on your screen a map of the current landscape of 11th Statement Of Work, QINQIO, and who’s serving your state or region.  These folks will be working with home health agencies to encourage them to participate in the Cardiovascular Data Registry and download the BPIPs on cardiovascular health Part 1 and Part 2, and it’s a phenomenal return of this setting to this work and a great opportunity to improve home health quality nationwide.

This brings us to the A in EDNA, which stands for assistance.  There are two areas of our assistance that I’d like to highlight today.  First of all is our HHQI Info Response System.  You see on your screen the email address hhqi@wvmi.org.  That is the email address that you can contact anytime with questions ranging from, “How do I download my data reports?” to, “How do I interpret this data, and use this information to set benchmarks and improve quality in my agency?”  We are here around the clock to help you with HHQI Info, just simply use that email address and you’ll be connected.

Another area where we provide specific assistance are for providers who serve a large proportion of health disparate population.  We do this to our underserved population or UP Network, which is a pioneering project in the home health setting to specifically target providers who may be in a small home health agency, or maybe in a unique urban or rural setting, or maybe a publicly funded or nonprofit, in addition to serving a high proportion of health disparities patients.  Among the UP Network resources, we have an existing excellent underserved populations Best Practice Intervention Package.  It’s just phenomenal, I cannot say enough great things about it.  If you’ve not checked out the existing UP BPIP, I strongly encourage you to visit homehealthquality.org and download it today.

As you’ll hear about here in a little while from Misty Kevech, we will be debuting a new focused Best Practice Intervention Package here on our 4th day specifically targeting underserved population and cardiovascular needs, so a lot more information to come for this.  You’ll also find on the UP tab of the HHQI website both a wealth of archived webinars with various topics that specifically speak to providers who serve underserved populations, and in our 4th phase we’ll be rolling out new webinars as well.  We’re always looking for partnership development and to work with people one on one who have a vested stake in eliminating health care disparities, and welcome that opportunity.

If you’re listening to this today and would like to partner on UP activities, please send us an email to hhqi@wvmi.org, and we would love to talk with you and either assist you or develop a partnership to help address health care disparities in the home health setting nationwide.  The UP Network also has its own e-newsletter, called the UPDate, which you can subscribe to on our website.  It will provide you information, updates, links, and free information having to do with underserved population from all over the country.  In our data reports there is inclusion of relevant data related to underserved populations as well.  So once you sign up to data access and start getting your both OASIS based and cardiovascular reports, you’ll see specific information related to the inclusion of underserved population.

So that’s an overview of the campaign.  Again, when you think of what we offer just think of EDNA, E-D-N-A, education, data, networking, and assistance.  If you have any questions you can chat them to Cindi Sun by selecting her in the chat box at any time during today’s presentation, and once we get through the presentations we’ll get to as many questions as time will allow for today.  So at this time I’m going to transition over, we’re going to talk a little bit more about key Phase 4 enhancements.  These all build upon the great successes, as Cynthia had mentioned, that we’ve experienced through our previous three phases and are really designed to help you as providers and stakeholders and QINQIOs do what it will take to bring home health to the next level and significantly improve quality nationwide.

So this time I will turn the presentation over to our lead HHQI cardiovascular project coordinator Cindi Sun, who’s going to tell you all about the brand new HHQI CardioLAN.  Cindi, are you with us?

Cindi Sun: Hi Shanen, thank you and welcome everybody and thank you for coming today.  We’re very excited to be able to share what our plans are, and we hope that you’ll find them as exciting as we do.  Now what I’m here to talk to you about today is just a little bit about the cardiovascular care in the home.  When we think of cardiovascular care provided in the home most of us would probably immediately envision patients with different types of heart failure, and it’s not necessarily wrong, since most cardiovascular care in the home has been focused on the prevention of heart failure and the exacerbation and prolonging the span of time between hospitalization.  This is been accomplished through strong agency leadership, clinician skilled assessment and symptom management, and patient and family education.  This is where home health as a whole has and continues to demonstrate strength.

Well what about the patients who may be receiving home health with diagnoses?  How about patients admitted for a non-cardiac diagnosis, yet may have an underlying cardiovascular disease?  They may be admitted to your agency for cardiac care, but does that mean that it’s not to be addressed in the home?  Now heart disease and stroke, you know these statistics and we’ve probably all heard them before, but I just wanted to bring them back to the table because these are pretty impressive.  Heart disease and stroke, number one and number four cause of death in this nation, and one out of three deaths are related to cardiovascular disease.  Yet the leading cause of preventable death is cardiovascular disease.  Then looking at the right hand corner, that particular bullet, the greatest contributor of racial disparity in life expectancy is cardiovascular disease, and if you’re not familiar with that staggering statistic I encourage you to look at the UP BPIP that Shanen mentioned earlier and the cardiovascular BPIPs that we’ll talk about in a minute, and look at the interactive map and really get a handle on these staggering statistics about the racial disparities in life expectancy with cardiovascular disease.

As Shanen mentioned earlier, the ABCS, this is where the ABCSs are applied.  Aspirin as appropriate, blood pressure control, cholesterol management, and smoking cessation.  Now to learn more about the Million Hearts initiative, we encourage you to listen to the Million Hearts executive director Dr. Janet Wright in an archive recording of the Home is Where the Heart Is, improving the ABCS of cardiovascular health.  That webinar is located on the HHQI website under the tab Webinar.  Now if you haven’t, if these statistics aren’t really grabbing your attention yet, let me ask you about your own patients.  Now although there is really not a box to check on OASIS in 2310 or 2430, but when a patient isn’t taking a prescribed aspirin or when a patient is smoking, but consider a primary cause of ER visits and hospitalizations in your patient population in the past 6 months.

May I ask you, how many of your patients have gone in for chest pain?  How about TIAs or even heart failure?  Now keeping those patients in mind, think about how many have an underlying diagnosis of hypertension.  Then the question is, “Was their blood pressure controlled prior to that ER visit or that hospitalization?”  Or what if they have a known history of a previous MI or a heart attack, “Were they supposed to be taking aspirin or a platelet inhibitor?  Was it of help?”  Evidence suggests that it would have.  But if you’re not already, we encourage you to begin to align your current improvement programs, what you’re already focusing on, and start aligning with a few additional preventative cardiovascular care ideas.  To help with this, HHQI has resources and tools such as the Cardiovascular Best Practice Intervention Packages or the BPIPs as we mentioned, and they’re focusing on the ABCS.

Now the newest guidelines for blood pressure control and cholesterol management can be found in the updates, as you see here.  Now this is really one of the few times that when simply tuning up the care every clinician and agency is providing can really make a dramatic effect on patient’s health.  As I said, it’s a very exciting time for home health because this is where it starts.  Now when implementing changes to any quality program, of course data is required to assess and guide the practice that gives the evidence behind what it is that you’re doing.  As we’re all aware, the primary data collection tool in home health is the OASIS and it doesn’t really capture this information, and this is the reason that Shanen mentioned earlier, that HHQI has developed the Home Health Cardiovascular Data Registry, HHCDR.  By an agency inputting just a very few pieces of patient data into the registry each month, HHQI will combine that with the information from the patient’s OASIS data that you have already transmitted to CMS, and this will create a monthly report that will help guide your practice.

Now when I say a few pieces of data, I mean very basic pieces of information will be required from the patient’s chart, such as if the patient has had a heart attack or stroke in the past, “Were they taking aspirin?  Yes or no?”  If they have a diagnosis of hypertension, “What was the final blood pressure before the patient left the agency?” and, “Was hypertension addressed during the episodic care?”  Again, “Yes or no?”  “Was there a lipid panel in the records?  Was the patient assessed for tobacco use?  If tobacco use was found, was it addressed in the home?  Yes or no?  Was the patient eligible for dual eligibility such as Medicare and Medicaid?”  Now these sound simple, and I realize that.  Many of you are probably thinking, “What in the world can you do with this?”

But it’s something to keep in mind.  These are the exact same measures that the physicians are held accountable.  Now for those of you in marketing I know, I can already hear your wheels turning, but implementing cardiovascular health practices will positively impact not only your patient’s health, which logically leads to less frequent ER visits and hospitalizations, this will also provide common focus and open the lines of communication with your community referral forces.  Now a few facts about the HHCDR, because we’ve been getting some questions already, so I just wanted to address them as soon as I could.

The registry will open on November 15th.  On this day on the 15th of every month moving forward, discharge patient data will be uploaded from the OASIS that your agency has already transmitted to CMS.  The CMS reporting health agencies will then have until the 14th of the following month to enter the data, and this is only from a few select patients, if not from every patient.  In fact you’re only required if you wanted a valid report to enter information on 12 patients per measure.  Again, knowing how busy you are time, restraint, this is created with all of that in mind.  It’s to make it as simple as possible yet while giving you the data to support what your actions are and to continue to improve the health of our patient.

Now HHQI will combine the two sources of patient data and produce your agency’s individual HHCDR report, and that will be released at the end of the month.  The report will demonstrate the progress your agency is making, as well as highlight any particular disparities in care that you may not even be aware of at that point.
Now the title of this presentation is Progressing Together, and to help with that we’d like to introduce the CardioLAN, that’s the Learning Action Network.  We invite everyone to join this network as it consists of agencies of varying stages of implementation in cardiovascular care.  The purposes of the CardioLAN is really in four parts, and you can see them there on the screen.  The sharing of cardiovascular knowledge and application of resources, now this will be accomplished with presentations and web discussions by experts in the field.  Opportunities for networking with other home health agencies from across the country with a common focus of improving cardiovascular care or possibly disparities in care, whether that is the racial disparity and age disparity, or possibly dual eligible population.  We’ll also be looking at urban versus rural disparities.  There are disparities all over when it comes to cardiovascular, but by working together all of us in one central core area, this is where we can at least address it, and as in the bottom left corner.  Hopefully we can try to identify opportunities for improvement, not just at the agency or patient’s bedside level but also at the state and national level.  As Shanen has mentioned before, we do want to offer you any type of direct assistance as we can, and being part of the CardioLAN is where we can try to implement that as well.
Now as part of the Cardio Learning Action Network, participants will receive the CardioLAN logo, the noting achievements and each of the milestones.  Now you can read on the screen the milestones we’re talking about.  The first milestone, sign up for the registry.  Milestone two, download the BPIPs and complete the security authentication.  Milestone three, abstract one month’s worth of data and download the report.  So as you can see they’re fairly simple, but at the same time it does denote where you are in progressing through the implementation of cardiovascular prevention in the home.

Now everyone can meet milestone one today by going to the Cardiovascular tab on the blue toolbar and on the HHQI website, and just click Data Registry.  When you do you’ll be taken to this page.  If you have not already done so, you can click the blue button to sign up.  If you want to see the other agencies not only in your state but around the country that are already signed up, you can click on the interactive map below that.

Now in closing I would just like to take an opportunity to restate the fact and to make sure that everyone is aware of this, Quality Innovative Networks, the QINs who were formerly called your QIOs, they are looking to support you in this cardiovascular effort.  We encourage you to contact the QIN listed for your state, which can be found on the network coordinator list on the HHQI website, and that’s under the About Us tab, partners and network coordinator.  You’ll find the network coordinators for your state or for your area, and that list will be updated on a weekly basis as we progress through.  So if you don’t see someone who’s representing your state at the QIN level and you’re interested, contact us at hhqi@wvmi.org, and we’ll be happy to get you in touch with the person who is leading home health improvement in your area.
For many of you it’s been a long six year wait for this opportunity to work with the QINs again.  Please take advantage of having the experts in your state ready and willing to help your agency.  With that I will say thank you, and pass this to Misty Kevech.  Misty?

Misty Kevech: Thanks so much Cindy.  We are very excited to have you today with us on this call, and we are going to talk about the HHQI education.  So I will get started here telling you that we’re going to be doing a lot of different methods of education, in a variety of topics, so let’s get started here.

In Phase 4 we’re going to build upon what has been successful in the previous campaigns and add some new, innovative ways for education.  Because there are very much different types of learners, and we want to use those learning styles.  We are also going to be bringing back some continuing education credits, and going to introduce some Spanish translations for many of the key patient education tools, and we’re going to talk about all of these methods of education in the next following slide.  So with the format, many of you that are HHQI historians with us are familiar with our primary BPIPs.  Those are the larger, more comprehensive packages that provides all the evidence based rationale, chock full of leadership education, implementation education, as well as tracks for nursing and therapy, social work, and home health aides.

So those are considered our primary BPIPs.  So new topics that we will be presenting in our fourth phase, we will be introducing these BPIPs to give us foundational pieces of information, resources at our hands.  But in Phase 3 we introduced what we called focused BPIPs, and we had huge success and a lot of great feedback on these shorter versions.  These are topics that there already was a primary BPIP out there and we were able to fine tune, taking a couple key points or intervention strategies within that best practice and a few key resources and tools, and provide that more down and dirty.  Even in our last two BPIPs in disease management for diabetes and for heart failure, we included a patient workbook, we included clinician tools and resources.  Once again, we got favorable feedback from assessments from agencies telling us what they liked.
What will be new is video BPIPs, and they will be new and upcoming this spring, and Crystal Welch will be here in just a little bit to tell you more about those.  Additionally, on top of the BPIPs we are going to be having online education courses, and these are going to be on demand through our exciting HHQI University that I’ll talk about in just a couple minutes.  So what I’d like to tell you a little bit about is some of the content that we intend to include in these best practice packages.  In the BPIPs, we’re going to include more down and dirty on steps for implementation, giving you templates and ideas of how to integrate these best practice strategies into your organization for small organizations, for large organizations.

We will definitely be making sure that it’s very clear on the connection to reducing acute care hospitalization or reducing readmissions, as well as reducing emergency department.  This connection is essential; this is the work that your local community health care facilities are working on.  This gives us a chance to work collaboratively and across setting.  We will definitely include that cross setting collaborative, including care transitions and ways that we can work interconnected, as we continue through this healthcare reform.  Underserved population Shanen talked about earlier, where we talk about the dual eligible, the health disparities, the underserved regions and even small home health agencies are considered underserved population.  We will continue to provide resources for that through the UP Networking, but additionally in each of the BPIPs we will include those pieces.

Quality improvement integration with other agency priorities.  Everyone’s working on something that is meaningful, or maybe you’re working on a project that your hospital facility is working on, but a lot of the projects tie hand in hand, just like Cindy talked about, with heart failure.  It doesn’t have to be our heart failure patients, but cardiovascular health ties into every one of our wound care patients, our diabetic patients, etcetera.  So we’re going to do more of that to be able to provide that connection for you.  Our topics in this first year are going to be very heavily focused on cardiovascular health, and you might ask, “Well, why?”  Well, cardiovascular health is significant if we can reduce, as the Million Hearts campaign indicates, reduce avoidable strokes and heart attacks.  But also its key work that in the 11th statement of work that Shanen talked about, the QINs, the QIOs are going to be working on, and can work with you in your organization.
So this is work that is being done in all setting and is significant for patient lives.  So we’ll be taking our cardiovascular BPIPs one and two, and the updates because we had those recent guideline changes at the end of last year.  We’re going to be working with those, and we’re going to be pooling out additional small focus BPIPs related to some of those topics.  We’re going to have a specific focus BPIP for the cardiovascular health for the underserved population.  We’re going to be doing clinician videos and education courses on things such as lifestyle management, self-monitoring the blood pressure.  Lots of the topics that were talked about in those packages, but breaking it into smaller, more easily digested chunks of information and education.

We’re going to provide a lot of the education that you’re not going to need to do because of our on-demand HHQI University.  So let me tell you a little bit about that.  It’s going to be our platform for learning, it’s going to be a very innovative, easy to use, very icon driven university where you’ll come on, you register as an individual, and you’ll have access to an evolving catalog of educational topics, and you will chose to enroll yourself into a course, take the course which will focus on those best practices for improving patient outcome.  It’s a way that we can really engage clinicians, that we can provide the education.  You could also opt to do this as a group activity as a face-to-face, and do the education component together but then have them take their education individually with their post-tests so that they would receive the credit.
So it’s an easy way for either us to help support the work that you’re doing or for us to help do your education for you.  So what is the audience for the education?  Well, we have education for leadership, we’ll be involved, we see that primarily a lot in our BPIPs.  But we’ll continue to provide lots of opportunities.  Nursing and therapy, social workers and aid, every single discipline is extremely important.  And also patients and caregivers, we can’t forget them.  Because if our efforts are not patient centered or where we can engage patients and caregivers, we’re not going to be successful with any type of disease management or any improvement in outcome.

So the content for these courses are going to include these evidence-based practices that will show how to integrate.  There’ll be a key tool or resource that’ll be easy to get to from the education component, because it will be displayed within the education.  There’ll be multimedia, that could be a short video to watch in conjunction to some reading, it could be a short webinar, there will be an evaluation in post-test.  Once the individual has passed the post-test successfully, automatically and easily within the university a certificate is produced, and it will also include any available continuing education credits right on the certificate.  They can print it, they can save it electronically, and if they need to come back to it back in their own account they will be able to see all their previous sessions and their certificates.

So let’s talk a little bit about some of the disciplines and continuing education.  Well, nursing is really our largest discipline, providing direct care to our patients and related to a lot of our outcomes.  So our focus will start by working with CEs for nursing.  We’re going to be able to make a lot of opportunities for CEs for our courses, but not all the sessions will have CEs.  We will make it very clear which do contain CEs.  We know this is a good way to get clinicians involved with doing the education.  So this is helping you, especially as leaders, to drive them to participating in the campaign or participating in the education.  Our CEs will be free, and that’ll begin early in 2015.  As we’ve mentioned, and we’re going to be presenting at NAHC next week and we get this question all the time, “Is it really, really free?”

Everything we do is free, because we are contracted with CMS and we’re working to help you as your organization.  Now all of our education will be approved through the American Nurses Credentialing Center, which is accepted in all the states, they at least recognize and accept that.  Now we don’t want to leave out the disciplines.  Our therapists are extremely important, and there will be education very specifically for therapy and how it applies, or how the general concepts and best practices apply for that discipline.  We will be looking at potentially some CEs later on for therapy, but for most of the therapy organizations, either state or national, they typically allow additional educational certificates from an outside source of their own organization.  We have had that happen with HHQI in the past, and it still does occur.  You can use our certificates for that purpose.

Social workers, the same way.  We know that there may not be as many social workers in numbers at an agency but they make a huge impact, especially with that underserved population.  Later on we will work on trying to provide some CEs for social workers, but we still will provide you with great resources to provide to your social worker.

Home Health Aide education, CMS’s regulations and rules are 12 hours a year.  So the education that we will provide with the BPIPs are a great way for you to build in and utilize some of those materials towards your hours for continuing education for the Aide.  They all will be available through our BPIPs.

Now patient education, we are going to create key tools or find key tools.  We want to find the best of the best to be able to offer to you.  Everything we do is free, there’s not a copyright, you can modify it as needed.  But we want to make sure that what we provide you will be health literate, it will be the right font and it will include the fifth to sixth grade as well as many of the other components to health literacy.  We will also provide Spanish translations, and I know probably many of you are going, “Finally, yay!”  We know that this has been a big request, and we decided to work on translating some of our past tools and resources that are patient-specific and key into Spanish translations, and we’ll be providing those for you as we go forward as well.

I know a lot of you may be thinking, “What about other languages?”  We have used some government statistics to show and validate, plus also we know what our enquiries has been that Spanish is the most requested, and we’re going to start there.  Even our BPIP videos that Crystal’s going to tell you about in just a moment, we also will have those translated for you as well, all for the patient videos.

So I’ve come back now to the same slide that I started, and I really want to express our excitement over HHQI education for this phase.  In all the forms and the courses as well as our learning platform through the university and CEs and our Spanish translation, we think we have some great, innovative, new things to offer for you to really try to support the work of the best practices that you’re trying to implement at your agency to affect each and every individual.  So with that Shanen, I’m going to turn it back over.  I guess I have another question slide.  If you have questions please to send them in to Cindy Sun in through the chat, and I’ll turn this over then to Crystal.

Crystal Welch: Well thank you so, so much Misty, and hello everyone.  As Shanen has alluded to, I’m going to talk briefly about the new approach to our Best Practice Intervention Packages, or BPIPs as we are referring to them, and they are coming in the spring of 2015.  Many of you are already familiar with the BPIPs, so in addition to the downloadable packages, as Misty was talking about, offered under the Education tab on our website.  We’re going to branch out and offer these video BPIPs.  This will be an exciting enhancement to our next phase, so we’re really, really looking forward to this spring.  The HHQI National Campaign is committed to helping you integrate the cardiovascular best practices, and we’re really excited to be developing these new Phase 4 video BPIPs.

This is an educational platform that will provide information, tools, and resources that your providers and your staff can use to make a measurable impact on those ABCS of cardiovascular health.  Each BPIP will provide a cross-setting approach, and these will be professionally produced and compelling, short videos, and be both clinician and patient-focused.  They’ll also be offered in English and Spanish versions as Misty said, just to increase the relevancy and benefit a much larger audience.  We’ll be using a multimedia approach to learning in order to reach different learner styles, and the videos will be able to be played on laptops, tablets, or your smart phone.

So the clinician video BPIPs, these are clinician targeted, and these videos are concise clinician education, designed to demonstrate best practices to providers to engage with their patients and their caregivers.  These videos will be convenient, on-demand and clinician focused, and as I said they’re short videos, they will cover key best practice topics, underserved issues like racial and ethnic risk factors related to cardiovascular disease, how to discuss smoking cessation with patients, tips on providing lifestyle management education.  As Misty Kevech mentioned just a few moments ago, in some cases there will be a key tool used in the video interaction, and this tool will link to the video education materials in HHQI University, just for easy access.
All video BPIPs will align with existing and new primary and focused BPIPs, to combine the types of educational delivery and how to integrate them into daily practices.  As Misty mentioned with the CEs, and evaluations, and post-tests, to complete the learning activity for clinicians and free nursing CEs for continuing education will also be new for 2015, so we’re really, really excited about that.

So how can we use the clinician video BPIPs?  Just some suggestions, add them to your agency education plan and activities.  You can supplement your current QI project plan, and you can play these videos at your staff or team meetings, and you can complete the post tests on your own for independent CE credit.  You can also just encourage clinicians to independently complete the videos and post-tests.  It’s just a great way to promote those free nursing CEs, as we mentioned.

So how about the second education platform, which is the patient video BPIP?  Patient targeted videos will be designed for patients to view themselves.  We’re going to encourage home health providers to play these videos for their patients on an internet-enabled tablet in the patient’s home.  It will be, again, concise and convenient, using on-demand HHQI platform with something, I believe YouTube.  So it’s just going to make this very simple and achievable.  To ensure the patients in areas without internet access can also benefit from these videos, we will be also providing downloadable files for clinicians to save directly to their device in order to play back without internet access.

These patient-focused videos will also be promoted, not only to patients, but to their families and caregivers as well, which just furthers that patient engagement in providing the necessary health issue education on topics like identifying the risks and signs of heart attacks and strokes, blood pressure medication management, and the cardiovascular effects of smoking.  The videos will use strategies that are key for patient’s best practices, and the appropriate key tools, like I said, will be linked in the video as well, if applicable.  There will be integration of patient tips, and again, they’ll be offered in both English and Spanish versions.

So how can we use the patient video BPIPs?  Well here are a couple of ideas.  Just encourage clinicians to use them to reinforce verbal and written order.  You can ask the clinician to sit and watch the video with the patient, and discuss the content.  In using methods such as the Teach Back, a method to determine what the patient understood and/or what needs more educational reinforcement after watching the video.  So those are some ideas, and just lastly this platform will just provide a different voice educating on the same content in a visual and auditory way, which just reinforces the various learning methods specific to our patient population.

I know specifically, I tend to be more visual.  So this just is going to be another exciting outlet for our patients to get more education and be able to use this method of delivering the best practice intervention package.  So with that, we just look forward to this launch and I just look for a tentative educational relief coming soon for video BPIP topics in the spring of 2015, and again if you have questions just please chat your questions to Cindy Sun.  At this point I’m just going to turn it back over to Shanen.

Shanen Wright: Thank you so much Crystal, and thank you Cindy and Misty for the great presentations that proceeded.  We’ve now come to the interactive portion of today’s webinar broadcast.  So as Crystal indicated, if you have questions please chat them in the chat box directed to Cindy Sun, and she’s going to gather them all up and we’ll get to as many as time will allow for today.  Our first question is directed toward Misty and this question asks, “What does dual eligibility have to do with cardiovascular health?”

Misty Kevech: Oh, that’s a great question.  Actually dual eligible patients typically are a lot of our lower socioeconomic patients to begin with.  So they really have a lot of barriers to healthcare in general, but especially with cardiovascular there are a lot of research articles that are out there that shows there’s a decrease in medical management adherence, resulting in higher blood pressures, the hypertension leads to higher risk factors for stroke and MI.  We also see sometimes a less coordinated care with those dual-eligibles.  Now we know that CMS has some new projects that are working on coordinating the Medicare and Medicaid in certain states, but we do find that these are very much still siloed, and so we might see them for an acute episode and then they lose contact even for their follow up with their PCPs.

We know they use the emergency rooms a lot.  We really look at the states that are higher in dual eligible, and a lot of times that is the lower southern states up through Tennessee, Kentucky, and also over to the Carolinas.  They tend to have unhealthier lifestyles and very much higher risk for strokes and heart attacks.  So there is a definite connection, and so there is still great work.  But we have to identify those that are dual eligible, and that is hard in a regular chart when you start looking at abstracting the data for the Cardiovascular Data Registry.

So I hope that will help, but that was a great question.

Shanen Wright: Our next question is for Cindy and this question asks, “How many records per agency need to be abstracted per month for participating in the Home Health Cardiovascular Data Registry?”

Cindy Sun: Well the questions coming in, you guys, are really good.  That’s another good one.  You can abstract as few or as many as you want, there’s a very broad question.  But in order to receive a valid report you would either need to abstract a minimum of 12 per measure or as many as your agency has, knowing that some agencies are smaller and they may only have five discharges in a month.  Well then it would be all five patients.

But the reason for the validity, it’s a random selection of 12 patients, you don’t select them the computer does.  It’s to prevent the hunting and pecking, if you will, of choosing which records to abstract.  That adds the validity to the report itself.  So it would be 12 records per measure, but usually the agency will have the ability to select which measures, whether you want to abstract for S from that month or do you want to just focus in on blood pressure, or many of you may just want to focus in on smoking especially if you’re focusing on wound care.  So you will choose at the beginning of the month which measures you want to look at, which of the ABCS, and that’s what will populate in your registry.  Then once you’ve completed them there’s a button that says, “Close out the month,” and if you do it by the 14th of the month then you’ll have a report a few weeks later.

If you forget or get distracted and have other things going on, which of course nobody has in Home Health, right?  But if that happens your data will stay there.  You can finish it up and close it out the following month.  So this is not [00:52:00]mandatory by any means, this is just an available tool to help collect the data that you will need to guide your practice.  That’s all it’s about, it’s just another tool.  But hopefully you’re able to see today that it is very simple and it’s not complex at all.  In fact, registering to access it is probably five times more complex than actually abstracting the information itself.

So thank you for that question.  Thanks Shanen.

Shanen Wright: Thank you Cindy.  We have a good follow up question to this as well that asks, “How do we select the twelve patients per month?”

Cindy Sun: You’re right, that is a good follow up and I may have answered that a little bit in the sense that you won’t be selecting it, it’ll be the computer itself.  Now one thing about that is that we have been asked the question, “Can you abstract more than 12?”  Absolutely.  Once you finish that 12th patient, the registry will automatically populate with all of your patients of all of the discharges of that month.  You can abstract those or you don’t have to, that’s your choice.  But the valid report just stops at 12 patients.  So if you’re short on time, which many are, 12 patients and you’re done.  Now many of the patients, if you select all of the measures, the ABCS, many patients will qualify for more than one measure.  So you may have, instead of thinking of it as 4 measures at 12 patients apiece which is 48 patients it’ll probably be, on average, about 30 patients total for all the measures.  But that will fluctuate depending on the underlying diagnosis of your patients.

One other thing Shanen, if I could just mention.  These diagnosis codes are coming from OASIS information.  You’re not entering them, you don’t have to do that, and that’s a great thing.  But at the same time, as we all know most Home Health patients have a few more than 5 or 6 or 10 diagnoses.  So with hypertension as an example, if hypertension is the patient’s underlying diagnosis it may not be captured in the registry.  When we were piloting this, that did seem to cause some anxiety so I just want to let you know out there that these are coming based on the OASIS information and the diagnosis code.  So, thanks Shanen.

Shanen Wright: Thank you Cindy.  Our next question is for Crystal and asks, “If we don’t have internet access, can we download a file of the video BPIPs once they’re available?”

Crystal Welch: Yes you can.  Just to ensure, because we know that there are areas, even rural areas and urban areas without internet access just because of affordability, connectivity issues.  So in those areas without internet access we can also always benefit from these videos because we’re going to provide downloadable files for clinicians and nurses, Home Health workers to be able to save directly to their device in order to be able to play back that information, those video BPIPs without internet access.  So that will be provided, because we certainly know that is very prominent.

Shanen Wright: All right, next question.  We’ll just go back to Cindy for a moment.  This question comes in and asks, “Do the patients in the registry have to have a cardiovascular diagnosis, or is it any patient?”
Cindy Sun: Thanks Shanen.  Yes, that’s another good question.  Certain measures, for instance the A for aspirin as appropriate in blood pressure, those are related to certain diagnoses such hypertension and ischemic vascular disease.  But as far as the cholesterol for the lipid panels, that’s based on age and the smoking is any patient from, 18 to 75 I believe is the age range.  The measures of how these are compiled can now be located under the data resources on the data access site.  You’ll notice the measures there and again, these are the PQRS measures of which the physicians in your community are held accountable for.  But these have been adapted for Home Health, just simply because of the nature of the setting.

But you can see on those how each of the patients comes in.  So yes, it will be all patients in the registry depending on which of the ABCS you select.  Thanks Shanen.

Shanen Wright:  Thank you Cindy.  Let’s go to a three-parter now for Misty.  These are all very similar questions, and since we’re running short on time we’re going to try to get to as many as we can.  These questions ask first of all, “I just want to make sure that the nursing CEs are free.”  “You mentioned CE use for nurses, but what about therapists and social workers?”  Last of all, “Will the continuing education credits be approved by all state boards of nursing?”

Misty Kevech: One, great.  Free, free, free, yes, yes, yes.  Yes, for nursing we are starting with that.  Therapists, we’re not leaving them out.  We’re still going to provide education, their certificates could possibly be used with their state or their national organizations.  We will work on trying to get some of those as we progress in this phase that are approved that would be eligible for all of the, for them to use.  For the ANCC, all the 50 states now accept ANCC with just a few, some of those have a little bit of requirements.  I think California and Iowa, you’re allowed to use so many from outside of your state.  But otherwise they’re accepted in every state at this point, and that is the national credentialing for nursing CEs.

Shanen Wright: All right, next question.  Let’s go back to Cindy for a moment.  This one asks, “How often will you be holding your LAN meetings for cardiovascular work, or the CardioLAN meetings?

Cindy Sun: Oh, that’s a very good question.  We’re going to hold them monthly, and it will be on the third Thursday of every month, starting in November.  It’ll be 2 o’clock Eastern and the notices will be located on the HHQI website, but we’ll also be sending out notification through those of you that have registered for the cardiovascular data registry.  Keeping in mind that that particular group, the CardioLAN, it’s not just for agencies, it’s for everyone.  So if you have any interest in cardio please feel free to join us.  We will have folks that are primarily Home Health, but those of you that are not associated with Home Health, that are in other cardiovascular aspects of the community, feel free to join us as well.  So we want to encourage everyone to participate in that.  Thank you for the question, Shanen.

Shanen Wright: Let’s squeeze in one more, Cindy, if you have the time to answer.  “Will you be able to register clinicians under the agency name or will they have to register individually?

Cindy Sun: Man you guys, these are really good questions.  All right, the registration for HHQI to be a participant, that is individual.  In fact we encourage everyone to register individually and not share an account.  There’s no reason to.  That’s just your choice how you do that, but there’s no reason to.  You’re not locking yourself into anything.  That way if somebody’s working in the evening at home and forgets the password they can change it and not mess everybody else’s account up.  As far as the registry itself, that’s through data access, and everybody can register individually.

Now there is a secured aspect to this, obviously, because you’re dealing with patient-level data as well as agency level data.  So that is a little bit more complex, but it is definitely individual basis.  We want to discourage the sharing of accounts, there’s no need to and it will also just cause you to mess up your own passwords probably.  So thank you.

Shanen Wright: Thank you Cindy, and for our final question today this asks, “Is there a website to find the Home Health Agencies registered with HHQI in each state?”  This segues perfectly into our next steps, yes.  If you visit homehealthquality.org, the National Campaign website and look under the About Us tab there’s a whole list of registered agencies right there that you can click on.  There’s a map so you can see all of the agencies that are registered for the Campaign in your state, and we encourage you to go out there and find out who’s participating.  For those of you listening today who are not yet participating, please go to the website so your name can appear there as well and you can show your commitment to quality by being a member of the Home Health Quality Improvement National Campaign.  It’s free, the resources are all evidence-based, and there’s really not a reason not to be participating.

So on behalf of all of our presenters today I’d like to thank you again for joining us for our Phase 4 kickoff webinar, and we sincerely look forward to progressing together with you as we move forward.  Thank you, have a great day.