Chronic Disease & Health Management Reconfiguring Health Systems, 2 nd edition

1. Chronic Disease & Health ManagementReconfiguring Health Systems, 2nd edition 22-23 September 2010, Bucharest, Romania The certification of chronic disease programs JCI Clinical Care Program Certification (CCPC) Carlo Ramponi, Managing Director JCI Europe

2. Transforming patient safety and quality of care A quick overview of our organization The Joint Commission • Leading accrediting body for health care institutions in the US • Founded 1951 • >15,000 accredited institutions JCR • Non-profit affiliate of TJC • Quality and safety innovations • Accreditation resources • Quality and safety risk areas • Founded 1986 JCI • Improving the quality and safety of patient care and achieve peak performance in the international community • Work with Health Care org’s, NGO’s and Government • 300+ Accredited organizations

3. We’ve worked in over 70 countries Countries with current JCI accredited organizations Head office

4. JCI Accreditation Update

5. Standards and Accreditation Span the Continuum of Care • Hospitals • Laboratories • Clinical Medical Transport • Care Continuum • Ambulatory Care • Clinical care program • certification • Primary care Programs

6. The JCI Roadmap High Performance Organizations Accreditation: Accreditation of the full organization Certification of excellent programs in unique capabilities Essentials: Validated achievement in self-assessment and improvement

7. Meaning of AccreditationJCI Definition • A voluntaryprocess by which a government or non-government agency grants recognition to health care institutions which meet certain standards that require continuousimprovement in structures, processes, and outcomes.

8. Meaning of CertificationJCI Definition • Certification is a process in which an entity, separate and distinct from the clinical care program, usually non-governmental, assesses the clinical care program to determine if it meets a set of requirements –standards - designed to improve the safety and quality of care. Certification is usually voluntary.

9. Concept of Standard Requirements that define performance expectations with respect to structure, process, and outcomes that must be substantially in place in an organization to enhance the safety and quality for patient care

10. An example of standard Hospital Program ASC.5.1 The risks, benefits, and alternatives of anesthesia are discussed with the patient, his or her family, or those who make decisions for the patient. Intent of ASC.5.1 The anesthesia planning process includes educating the patient, his or her family, or decision maker on the risks, benefits, and alternatives related to the planned anesthesia and postoperative analgesia. This discussion occurs as part of the process to obtain consent for anesthesia (including moderate and deep sedation) as required in PFR.6.4, ME 2. An anesthesiologist or a qualified individual provides this education. Measurable Elements of ASC.5.1 1. The patient, family, and decision makers are educated on the risks, benefits, and alternatives of anesthesia. (Also see PFR.6.4, ME 2) 2. The anesthesiologist or another qualified individual provides the education.

11. An example of standard CCPC Program

12. Accreditation VS Certification (1) MACRO SYSTEM MICRO SYSTEM Primary Stroke Program Heart Failure Program Cardiac Program Acute Myocardial Infarction Program COPD ACCREDITATION CERTIFICATION

13. JCI HOSPITAL STANDARDS 4rd: International Patient Safety Goals Access to Care & Continuity of Care Patient and Family Rights Assessment of Patients Care of Patients Anesthesia and Surgical Care Medication Management & Use Patient & Family Education Quality Improvement & Patient Safety Prevention & Control of Infection Governance, Leadership, & Direction Facility Management & Safety Staff Qualifications & Education Management of Communication & Information JCI CCPC STANDARDS 2nd: International Patient Safety Goals Program Leadership & Management Delivering or Facilitating Clinical Care Supporting Self-Management Clinical Information Management Performance Measurement & Improvement Accreditation VS Certification (3)

14. What is Clinical Care Program Certification? • CCPC is designed to evaluate disease management and/or condition–specific care programs that are provided by hospitals and other care delivery settings. • CCPC is based on a clear assessment of consensus-based standards and criteria, the effective use of clinical guidelines, and an organized approach to performance measurement and improvement. JCI Standards Quality Outcomes for the Population Note: Adapted from TJC DSC Model

15. Eligibility CriteriaJCI Approved CCPC Programs Diseases / Conditions/Services: • Heart Failure, • Acute Myocardial Infarction, • Primary Stroke, • Diabetes Mellitus (type 1 and 2) • Chronic Kidney Disease (Stage 1 to 4) • End –stage renal disease • Palliative Care (all types) Diseases /Conditions/Services: • Traumatic Brain Injury, • HIV/AIDS Management, • Cancer (any types), • Chronic Obstructive Pulmonary Disease (COPD) • Asthma. • Pain Management, • Joint Replacement (any types), • Transplantation (any types). The organization’s program has to be one of the 15 JCI approved CCPC programs

16. Eligibility: Clinical Practice Guidelines (1) • Evidence-based recommendations in the CPG(s). • Sponsored and supported by the auspices of medical specialty associations; • Sponsored and supported by relevant professional societies; • Sponsored and supported by public or private organizations, government agencies or other authoritative sources.

17. Eligibility: Clinical Practice Guidelines (2) • JCI Certification will accept the four most common grading systems used today (GRADE, SIGN, NICE and CEBM-Oxford).

18. Eligibility: Performance Measures • Performance measures selected are appropriate and consistent with the program’s intent and/or Clinical Practice Guidelines. • The program agrees to collect and submit data for relevant performance measures selected by JCI (two of the four are JCI selected).

19. Eligibility: Host Organization • The program’s host organization or one of the parent network organizations is JCI accredited; or • for the non-JCI accredited organizations, host organization agrees to be evaluated on some specific topics which may vary according the type of program

20. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. • International Patient Safety Goals 6 • Program Leadership & Management 15 • Delivering or Facilitating Clinical Care 7 • Supporting Self-Management 5 • Clinical Information Management 7 • Performance Measurement & Improvement 8

21. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. International Patient Safety Goals • Identify Patients Correctly • Improve Effective Communications • Improve the Safety of High-Alert , high risk Medications • Eliminate Wrong-side, Wrong-patient, Wrong-procedure Surgery • Reduce the Risk of Health Care-acquired Infections • Reduce the Risk of Patient Harm Resulting from Falls

22. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. Program Leadership & Management • Designing and implementing program • Evaluating program • Providing adequate access to care • Conducting program in an ethical manner • Supplying reference resources to staff • Requirements of facilities that “host”

23. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. Delivering or Facilitating Clinical Care • Using qualified, competent, trained staff • Staff orientation • Evaluation of care provided • Delivering care using evidence-based practice or clinical practice guidelines (CPGs) • Individualizing care to meet patient’s needs • Management of co-morbidities/concurrent conditions

24. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. Supporting Self-Management • Involving patients and families in making decisions • Evaluating patient and family’s ability to learn • Evaluating the patient and family’s learning needs • Educational materials • Lifestyle changes that support self-management

25. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. Clinical Information Management • Protecting patient information • Identifying those authorized to access records • Use of standardized documentation • Internal and external information needs • Gathering and Providing information across continuum • Each patient has a clinical record

26. CCPC Program structure JCI CCPC STANDARDS 2nd Ed. Performance Measurement & Improvement • Approach to performance improvement • Maintaining data quality and integrity • Using data to improve processes and outcomes • Addressing sentinel events • Addressing adverse events • Addressing “near-miss” events • Variances related to CPGs • Evaluating patient and family satisfaction

27. Program’s Background and Status Update • As of 25 Feb 2010, there are 22 Certified programs in 8 countries, with two non-JCI accredited host organizations: • Acute Myocardial Infarction programs (6) • Primary Stroke (5) • Cancer programs (4) • Heart Failure programs (2) • Palliative Care program (1) • Pain Management program (1) • Osteoarthritis of the Knee program (1) • Outpatient Diabetes Mellitus Type 2 (1) • Chronic Kidney Disease (1

28. Conclusions • Certification provides a visible commitment by a program’s leaders and staff to improve the safety and quality of patient care, ensure a safe care environment, and continually work to reduce risks to patients and staff. • JCI certification program has been designed to create and maintain a culture of safety and quality within a program that strives to continually improve patient care processes and results

29. Thank you For more information: • On JCR products and services • www.jcrinc.com • +1630-268-7400 • On JCI accreditation and advisory services and publications • www.jointcommissioninternational.org • +1630-268-4800 • WHO Collaborating Centre for Patient Safety Solutions • http://www.ccforpatientsafety.org/ • +1630-268-7467 • On JCI Europe Office • http://www.jointcommissioninternational.org/european/JCIs-European-Region/