Baptist Health Clinical Effectiveness: Supporting Best Practices for Heart Failure Patients

(TL4EO_CHF Clinical Effectiveness Team Presentation March 3, 2008)

Agenda March 3, 2008 I Call to Order II Introduction of members III ORYX Performance Measures IV Quality Management CHF Rate of compliance to best practice V Examples of Outliers VI Baptist Health 2008 CHF Goals and Objectives PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

CLINICAL EFFECTIVENESS: CORE PROCESS The process for supporting and developing Clinical Effectiveness goals is led by physicians and supported by a multidisciplinary team including hospital administration, nursing, ancillary expertise, and others. Process Overview • Define critical clinical outcomes - Physicians determine the desirable treatment objectives for the specified patient population. • Define the key decision points - Physician experts determine the key decision points for acute treatment process (e.g. admission, diagnostic evaluation, treatment, etc.). • Initiate MD led subgroups - Multidisciplinary subgroups led by physicians focus on developing interventions to address hypotheses about the best practice use of specific interventions and resources. • Review medical literature (the Evidence Base) - Subgroups collect literature for the physician and subgroup to use in the development and refinement of the above hypotheses as a key to defining best practice. • Develop intervention - From the evidence in the literature and the clinical expertise of the group, the group develops specific interventions to support best practice. They review current practice pattern data against their developed best practice objectives. • Design outcome measures - To capture the impact of the best practice definitions and interventions on patient outcomes, the group designs outcome measures and methodology. • Create operational plan - Develop operational support mechanisms and process so that best practice interventions can be realistically realized. PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

ORYX Measures Performance Improvement involves reviewing and comparing our organization with other like facilities to ensure best practices. In order to compare BHS with other facilities we need to collect data. The name of the Joint Commission requirement to collect data is called ORYX. Our data is collected and then sent to the Joint Commission for review. One of the performance measures our organization has submitted to meet Joint Commission ORYX performance measure requirement includes Heart Failure The Joint Commission and the Centers for Medicare and Medicaid Services began working together to align measures common to both organizations. These standardized common measures are called “Hospital Quality Measures” PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

ORYX Measures HF-1 • Performance Measure Name: Discharge Instructions • Description: Heart Failure patients discharged home with written instructions or educational material given to patient or caregiver at discharge or during the hospital stay addressing all of the following: • 1. Activity level • 2. Diet • 3. Discharge medications • 4. Follow-up appointment • 5. Weight monitoring • 6. What to do if symptoms worsen PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

ORYX Measures HF-2 • Performance Measure Name: Evaluation of LVS Function • Description: Heart Failure patients with documentation in the hospital record that left ventricular systolic (LVS) function was evaluated before arrival, during hospitalization, or is planned for after discharge. PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

ORYX Measures HF-3 • Performance Measure Name: ACEI or ARB for LVSD • Description: Heart Failure patients with left ventricular systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications who are prescribed an ACEI or ARB at hospital discharge. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction. PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

ORYX Measures HF-4 • Performance Measure Name: Adult Smoking Cessation Advice/Counseling • Description: Heart Failure patients with a history of smoking cigarettes, who are given smoking cessation advice or counseling during hospital stay. For purposes of this measure, a smoker is defined as someone who has smoked cigarettes anytime during the year prior to hospital arrival. PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Quality Management: Heart Failure Best Practice Compliance Discharge Instructions PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Quality Management: Heart Failure Best Practice Compliance 98% target is based on system wide goal determined by senior leadership *Preliminary data used in 2007Q4 PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes. Source: Trendstar, Premier Quality Measures Reporter

Quality Management: Heart Failure Best Practice Compliance Evaluation of LVS Function PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Quality Management: Heart Failure Best Practice Compliance ACEI or ARB for LVSD PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Quality Management: Heart Failure Best Practice Compliance Adult Smoking Cessation Advice/Counseling PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Quality Management: Heart Failure Best Practice Compliance Adult Smoking Cessation Advice/Counseling 98% target is based on system wide goal determined by senior leadership *Preliminary data used in 2007Q3 PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes. Source: Trendstar, Premier Quality Measures Reporter

PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Baptist Health 2008 CHF Goals and Objectives • In order to attain the targeted goal of 98% compliance in all CHF ORYX Measures: • Focus Area 1 -- ACEI/ARB • Physician driven measure – suggestions, thoughts, ideas? • Focus Area 2 -- Discharge Instructions • Collaboration between Physician and Nursing • e-Learning • CHF Core Measure Module • Medication Reconciliation Module • Save Note and CHF Booklet • Change to the Medical Surgical Discharge Instruction Form PRIVILEGED AND CONFIDENTIAL This Baptist Health document is not subject to discovery pursuant to Florida statutes.

Baptist Health Clinical Effectiveness: Supporting Best Practices for Heart Failure Patients