MaineHealth Clinical Integration Summary of Annual Reports

1. MaineHealthClinical Integration Summary of Annual Reports FY2009 Evaluation (October 2008 – September 2009)

2. AMI PERFUSE • Goals / Aims • Individuals who experience an ST-Elevation Myocardial Infarction (STEMI) in the MaineHealth community will receive the highest quality of care and achieve the best possible outcomes, regardless of their point of entry into the system. • Outcomes • Increased the percent of patients that received timely diagnosis and treatment. • All hospitals are following best practice guidelines from the ACC/AHA. • Activities • Analyzed and trended hospital-specific data quarterly and fed back to respective hospitals • Updated and customized treatment tools. • Built new relationships with EMS providers. • Lessons Learned / Next Steps • Using EMS providers as an extension of the ED improves STEMI patient care. • Prompt feedback to hospital providers encourages continuous quality improvement.

3. Anticoagulation Management • Goals / Aims • Search and discover, and gather information about anticoagulation management methods in the inpatient and outpatient settings • Outcomes • Reported high-level findings of system-wide survey • Held system wide summit to review current literature, share best practices and identify needs • Lessons Learned / Next Steps • There is a need for and a defined interest in continued pursuit of anticoagulation issues at the MaineHealth system level • Review proposal with CI Leadership and CISC • Determine rates of thromboembolic and hemorrhagic complications • Activities • Conducted site visits to Anticoagulation Clinics within system • Assessed compliance with National Patient Safety Goals and Leap Frog • Held a system-wide anticoagulation conference

4. AH! Asthma Health • Goals/Aims • Increase awareness and utilization of quality care measures for pediatric and adult asthma and COPD • Increase self-management education throughout MH system • Reduce hospitalizations and emergency visits • Outcomes • Patients receiving asthma education increased 37% • Trained over 890 practice and hospital staff • Distributed over 20,000 tools including 900 clinical guidelines to practices and clinicians in the MaineHealth system • Activities • Initiated collaboration with Center for Tobacco Independence to create combined asthma education and tobacco treatment services • Led re-design of patient education guide and statewide asthma action plan • Selected by Environmental Protection Agency and Agency for Healthcare Research & Quality as model program • Produced Public Service Announcement with statewide partners • Lessons Learned / Next Steps • Implement asthma education/tobacco treatment at Stephens • Support development of AH! Program at 2 MaineHealth hospitals • Support implementation of COPD pilot program atSouthern Maine Medical Center • Determine strategy to address need for increased adherence to quality measures

5. Cardiovascular Health • Goals / Aims • Reduce the burden of CVD in ME • Advance patient and family-centered cardiovascular care initiatives and health care team support • Outcomes • Development and implementation of Blood Pressure Program; eight in-services completed • 64% participation rate in CR data collection • Activities • Cardiac Rehab (CR) Sub-Committee • Blood Pressure Measurement Review and Update Program (Blood Pressure Program) • Healthy Eating Guide • CVH/HF Clinical Consultant • Faculty Advisor, PRISM 10: Population Health • Lessons Learned / Next Steps • Broad multi-stakeholder participation critical for success of programs/materials • Continue roll out of primary prevention via Blood Pressure Program • Re-structure CR Sub-Committee to improve efficiencies and communication • CVD Leadership Group to inform Health Index Workgroup

6. Eldercare: A Matter of Balance • Goals / Aims • Support and promote the dissemination of A Matter of Balance Nationally • Successful implementation of business plan • Online distribution of materials • Online Store Outcomes 8 National and state presentations 4 Articles in publications and newsletters 80 Telephone and e-mail inquiries 4 MOB e-newsletters website Updated 100% satisfied with training Activities 12 Master Trainer Sessions 210 Master Trainers trained >10,000 older adults completed class since 2007 • Lessons Learned / Next Steps • Continue with National and International dissemination of A Matter of Balance • Continue technical assistance through email, telephone, meetings, newsletters • Maintain ordering through J.S.McCarthy

7. Eldercare: Care Transitions Program • Goals / Aims • Improve patient/ caregiver knowledge and self-management skills during transitions of care. • Decrease 30-day hospital readmission rates. • Outcomes • Patients report increased self-management skills and would recommend the program. • Reduced 30-day readmission rates compared to Medicare data. • Lessons Learned • Greater knowledge and confidence in self-care skills leads to enhanced ability to ensure needs are being met during this vulnerable time. • Patients and caregivers playing a more active • role results in reduced re-hospitalization rates. • Next Steps • Expand program to other MaineHealth members. Activities A Nurse Care Transitions Coach meets with the patient in the hospital, makes one home visit and provides three follow-up phone calls during a 4-week period.

8. Eldercare: Culture Change Workgroup Goals / Aims Improve the resident and family experience in MaineHealth long-term care nursing facilities by embracing the concepts of culture change to transition away from traditional institutional-centered care to person-centered care. • Outcomes • Primary nursing and CNA assignments introduced. • Changes in the dining experience implemented or being planned. • I Care Plans explored or introduced. • Activities • Completed theCMS Artifacts of Culture Change Survey • Opportunities for improvement identified. • Lessons Learned • Workgroup members are at varying stages of the culture change journey providing all with an opportunity to be both teachers and learners. • Next Steps • Measure resident and family experience regarding culture change. • Develop culture change education curriculum.

9. Eldercare: Fall Prevention Workgroup • Goals / Aims • Improve quality and safety by implementing a system-wide fall prevention initiative across the long-term care continuum. • Decrease falls and fall-related injuries. • Outcomes • Fall and injury rates tracked. • Uniform post-fall assessment tool adopted. • Activities • Utilized common definitions and fall rate calculator to track falls and injury rates; discussed data and learn from each other at workgroup meetings. • Adapted the TRIPS (Tracking Record for Improving Patient Safety) form for post fall assessment. • Lessons Learned • Shared fall prevention strategies. • Next Steps • Adapt the Falls Management Program for each setting. • Develop teaching and presentation tools to provide fall prevention education for all.

10. Eldercare: Healthy Choices for Me • Goals / Aims • Statewide Dissemination of 5 Evidence Based Healthy Aging Programs • Strengthen Regional Networks • Outcomes • 3,275 Older Adults reached statewide with EBP programs. (10/06 – 7/09) • Regional Lay Leader Training • Activities • Train the trainer model • Regional Coordination through the aging network-Area Agencies on Aging • Lessons Learned / Next Steps • Development of Regional Coordinating Centers • Development of Physician Practice based programming • Development of employee sponsored programming

11. ED Psychiatric Care Workgroup • Goals / Aims • Improve quality of psychiatric patient care in all MaineHealth EDs. • Standardize care of psychiatric patients across all MaineHealth EDs. • Outcomes • Reduction in orders for unnecessary labwork. • Standardization of medications used to treat agitated patients. • Activities • Developed Medical Clearance Protocol for Inpatient transfers • Developed Treatment of the Agitated Patient • Lessons Learned / Next Steps • Working to lower length of stay in MaineHealth EDs

12. Healing Hearts, Heart Failure Program • Goals / Aims • Provided system-level coordinated program to ensure standardized approach to HF across care settings • Increased variety and availability of patient and provider tools • Outcomes • 283 scales distributed in FY’09 (↑ of 36% from FY’08) • Workgroups held two joint meetings to improve communication and transitions across the care continuum • Activities • Successful implementation of Home Health Clinical Pathway for HF Care and creation of provider modules • Hired CVH/HF Clinical Consultant • Developed materials/ programs for patients: Living Well with HF series • Used data to focus on preparing strategy to ↓readmission • Lessons Learned / Next Steps • Develop a collaborative strategy to reduce HF readmissions is critical for FY’10; joint workgroup integral to efforts • Accommodate acute need for outpatient ed (e.g., expansion of LW with HF series) • Continue with provider education and improvement (e.g. pathway evaluation and ed modules)

13. Infection Prevention • Goals / Aims • Improve hand hygiene compliance • Adopt national infection reporting • Influence public policy on infection prevention • Raise awareness of MRSA • Outcomes • 95% of hospitals improved compliance • 6 hospitals adopted national reporting • Influenced Maine legislation re: MRSA surveillance • 30+ community presentations • Activities • Hand hygiene performance improvement process • Engaged hospitals state-wide • Developed testimony, key points for legislators • Conducted trainings for reporting • Lessons Learned / Next Steps • Increase focus on MH hospitals in hand hygiene improvement • Eliminate variations in hand hygiene data • Tie hand hygiene improvement data to infection rates

14. MaineHealth Learning Community • Goals / Aims • To provide educational opportunities to healthcare providers and professional staff, thereby supporting the delivery of efficient, evidence-based, high quality patient-centered care to continually improve the health of our communities • Outcomes • % of MPHO Members Reached:1 69% • Overall Satisfaction Results:2 90% • MHLC First-Time Participants: 30% • 1. Of those who participated in the evaluation process • 2. Participants who completed the evaluation that agreed or strongly agreed with the overall quality of the program. • Activities • Practice Improvements Series Mtgs. (PRISM) • Educational Outreach Sessions • Practice Networking • Quarterly E-News Letters • Lessons Learned / Next Steps • Continued high demand, satisfaction and demonstrated growth • Obsolete operational processes being addressed • Expanding beyond traditional approach • Invested in new technology to increase efficiencies and better serve our customer

15. Oncology • Outcomes • Validated goals of cancer plan • Convened Quality Steering Committee • Prostate, breast screening guidelines endorsed • Identified access issues to specialty care • Goals / Aims • Validate goals of cancer plan • Convene a Quality Steering Committee and develop guidelines • Explore ways to improve access to clinical trials and genetics counseling • Explore ways to improve access to specialty services • Activities • Met with Senior Management of each member and affiliate hospital • Convened Quality Steering Committee and cancer site specific work groups • Explore options to improve access to clinical trials and also specialty services • Next Steps • Explore centralized IRB • Convene governing body • Continue to develop screening and treatment guidelines • Explore benefits of navigational resources

16. Orthopedic Joint Replacement Registry • Goals / Aims • Registry Development • Registry Enrollment • Data Collection/Analysis • Aim: Provide data to participating hospitals for use in quality improvement initiatives • Outcomes • Data collection process implemented • Five MH hospitals currently enrolled • One year of data collected • Activities • Re-design of data collection format/process • Preliminary discussions with EMH/EMMC regarding possible participation • Enrollment of other MH hospitals and outside organizations • Lessons Learned / Next Steps • Consistent software “versions” crucial to efficiency in the collection and reporting of data • Develop a new data collection format and process

17. Palliative Care • Outcomes • All initiatives are under development and in a foundation building status consistent with an emerging program • Held a palliative care symposium with a national speaker was held in Portland in June 2009 • Established a statewide coalition to advance use of POLST • Goals / Aims • Convene Quality Steering Committee • Advance use of Physician Orders for Life Sustaining Treatment (POLST) in Maine • Develop informative web site for public and health professionals • Develop and promote educational opportunities for health professionals • Activities • Established Quality Steering Committee • Convened statewide POLST Coalition • Collected general palliative care information for web site • Held Palliative Care symposium • Next Steps • POLST Coalition will identify strategies going forward • Quality Steering Committee will identify quality metrics and reporting mechanism

18. Preventive Health Program • Goals / Aims • Deliver consistent, high quality care across the MH region • Provide best-practice, evidence-based tools and support to primary care practice teams • Introduce strategies for improving preventive health • Outcomes • Endorsed clinical guidelines for adult and pediatric populations • Developed educational materials for patients and electronic resources/tools for providers including the Preventive Health module within Clinical Improvement Registry (CIR) • Activities • Convened Preventive Health Workgroup and Physician Task Force to provide clinical expertise • Engaged CI chronic disease programs in supporting and promoting prevention • Formed cross divisional MH Pediatric Preventive Health Team to collaboratively address Child Health • Lessons Learned / Next Steps • Competing demands on PCP may impact the adoption of the new PH program and CIR module • MH’s enterprise wide process redesign effort has resulted in a cross divisional Pediatric Preventive Health team working collaboratively to improve children’s health

19. Primary Care Mental Health • Outcomes • 21 practices involved in mental health integration (MHI) activities • Revised mental health assessment tools – adult & child • 47% of pts with CVD &/or diabetes in CIR screened for depression • 33% of PCPs complete Module 4 • Goals / Aims • Increase scope of integration efforts • Improve depression care in primary care • Activities • 3 Learning Sessions • Supporting practices to implement and spread MHI • Depression Module 4 deployed • Link to other MaineHealth, statewide, and national initiatives • Lessons Learned / Next Steps • Link to Patient Centered Medical Home pilot and other chronic condition programs • Pilot MaineHealth Employee Health collaborative care for depression • Develop and market business plan for Mental Health Integration

20. Stroke • Goals / Aims • Support improved stroke systems of care via protocols, training & data collection • Increase availability of neurology consultation via telehealth • Support MH hospitals in educating stroke patients & families • Outcomes • Hospitals implemented protocols & new data collection systems • EMS providers demonstrated improvement in stroke care knowledge • MH hospitals use stroke guide to educate stroke patients & families • Increased tPA administered via telestroke • Activities • Developed dysphagia screen recommendations & tools • Supported successful telestroke pilot • Conducted EMS stroke training • Disseminated stroke guide • Lessons Learned / Next Steps • Need good information on barriers to actual implementation of stroke systems • Web-based training valuable for EMS • Data collection for performance improvement is next major focus

21. Target Diabetes • Goals / Aims • Prevention • Public Awareness • Patient Education • Provider Support • Outcomes • Diabetic patients in Maine Physician Hospital Organization Registry = approximately 25,000 • Process: 47% recorded on all 6 specified measures (55% in FY08) • Outcomes: 14% = optimal range 30% = intermediate range (15% and 31% respectively in FY08) • Activities • Increased focus upon Inpatient Glycemic Control (IpGC) among all MH hospitals; IpGC conference November 2009 • Patient Self-Management support via development of education tools; RIM sessions • Provider support via development of clinical tools and clinical consultation • Lessons Learned / Next Steps • Outcomes data key to assisting improvement processes within MaineHealth (MH) community - Inpatient/Outpatient. • Continue development of IpGC initiative throughout MH hospitals • Improve procedures for transitioning patients with diabetes within the healthcare system

22. Telehealth Program • Goals / Aims • Develop a system level strategy for telehealth services • Expand telehealth reach and services • Improve access to care in rural communities • Outcomes • Secured program funding for 2010 • Hired Program Manager and dedicated IT resource • Developed vision statement and guiding principles for program • Activities • Strategic Planning Retreat held • Planning committee convened • Workplan developed including critical elements for success • Collaborated on IS funding for new teleconferencing platform for MMC • Lessons Learned / Next Steps • Significant unmet telehealth needs across MaineHealth. • Strategic planning and sound business plan needed to ensure success and sustainability. • Implement/expand 2 projects for FY2010