HHQI Campaign Survey Results

Best Practice Intervention Package (BPIP)
HHQI Survey Summary
January 2008

Which states had the highest participation in the BPIP survey based on the number of state agencies participating in the HHQI campaign?
South Dakota, Maine, New York, Indiana, New Hampshire, New Jersey, Pennsylvania, Rhode Island, Wisconsin, Kentucky, Kansas, and Hawaii

Which states had 15 or more agencies participate in the BPIP survey?
Texas, Pennsylvania, Illinois, Missouri, Florida, Minnesota, Oklahoma, Indiana and Ohio

What did the survey participants list as their motivation to register for the campaign?

67%QIO recommendation

47%Premier agency status

34%State Association recommendation

15%Key stakeholder endorsement

Other reasons for registering to participate included, commitment to quality and to obtain resources and reports.

What did the survey participants list as their motivation to continue active participation in the campaign?

93%Monthly Best Practice Intervention Packages

53%Statewide Participation

46%National Initiative

30%National Teleconference

26%Articles in Industry publications

13%Agency of the Month Selection

Other reasons for continued participation included desire to improve patient outcomes, free CNEs, and preparation for P4P

What Best Practice Intervention Packages did survey participants identify as helpful?

89%Hospitalization Risk Assessment

75%Phone Monitoring and Frontloading Visits

74%Fall Prevention

73%Medication Management

72%Emergency Care Planning

49%Patient Self-Management

47%Disease Management

42%Physician Relationships

41%Immunizations

38%Teletriage

36%Telemonitoring

Specific tools that were identified as especially valuable and helpful: (links included with tool name)
Hospitalization Risk Assessment
My Emergency Plan
Call Me First
SBAR
Orthostatic Hypotension Assessment (Leadership Track page 27)
Teletriage assessments (Under Associated Resources)
Telemonitoring Checklist
Fall Assessment
Beer’s Criteria
Phone Monitoring and Frontloading Visit Checklist

What sections of the Best Practice Intervention Packages did the survey participants use and find the most helpful?

86%Nurse Track

49%Leadership Track

35%HHA Track

34%Therapy Track

28%Associated Resources

23%Monthly Poster

12%Connection Pages

10%MSW Track

A few agencies identified that the Fast Track was the most helpful section for their agency.

How many of the survey participant’s staff utilized the free continuing education opportunities?

47%

Please note that all continuing education opportunities will end on February 29, 2008!

How many of the survey participants utilized the audio CDs that were mailed quarterly to all HHQI participating agencies?

65%

A few agencies remarked that they did not receive copies of the audio CDs. The audio CDs were mailed to the registered addresses of all participating HHQI agencies. Agencies that joined later in the campaign would only receive the CD mailings after the date they joined the campaign, no prior mailings were forwarded to new participants.

Also—several agencies commented that they are downloading the podcasts and putting them on CDs. The mailed CDs contain the same podcasts that are posted online. (Often times several topic areas are combined to one disk in the mailed versions) Agencies can use the CDs to archive the podcast information for future use.

Please note that the last CD mailing will include Disease Management and Transitional Care Coordination podcasts for both clinicians and for home health aides. These will be mailed at the end of January. Agencies should receive this final CD mailing by mid-February.

How many of the survey participants utilized the podcasts that were available for each package?

39%

How many of the survey participants utilized the monthly HHQI reports?

94%

Agency Question/Comment

HHQI Response

Have the data come a little closer to real time data (not 5 months behind).

Note that the 1st page of the report is concurrent with the OBQI reports from the CASPER system, which are always 2.5 months behind real-time. This is to ensure that the data reflects all OASIS assessments for each 12-month period. The 2nd page of the report does contain OASIS data that is one month more recent than the OBQI reports (e.g., the HHQI reports your agency receives in January 2008 would include OASIS data from November 2007.) The 2nd page of the report contains data that is not risk adjusted, but provides more current information to your agency.

It would be helpful to have the top 20% numbers for the state as well as nation.

The Statewide 10th and 20th Percentile Rates are included on the 1st page of the report.

Quality of print not the best, could they be emailed directly to the agency?

These reports have to be mailed through the US Postal Service because they contain confidential information. E-mail is not a suggested vehicle to carry confidential information.

Can you report by diagnosis?

Unfortunately, no. The OASIS data is based only on discharge assessments, not Start/Resumption of Care assessments. This means that we can only identify hospitalizations by Reason for Hospitalization, which is identified in M0895 (2nd page of the report).

I would like more one on one direction of how we can use this information with staff and other leaders in the organization to help our cause.

Direction on how to use the report is posted on http://www.homehealthquality.org/hh/hha/faqs/reports.aspx

Additionallyyour state QIO can help you understand how to review and better utilize the reports.

The data is very beneficial in helping us make the decision for weekly calls to patients with HF.

A great example of linking the data on the HHQI reports to a proactive intervention!

This is the most valuable part of the program for us.

Thanks! We received several requests to continue the reports. Based on this feedback, we will continue to provide the reports to each state’s Quality Improvement Organization (QIO) through July 31, 2008.

How many of the survey participants identified the HHQI Tips of the Week as valuable and informational?

73% (12% did not utilize and 11% did not receive)

How many of the survey participants identified the HHQI Monthly Calendar as valuable and informational?

45% (30% did not utilize and 18% did not receive)

How many of the survey participants identified the BPIP Educational WebEx as valuable and informational?

51% (33% did not utilize and 13% was not aware that it was available)

The Best Practice Intervention Packages (BPIPs) were released monthly throughout the 12-month campaign. What did the survey participants identify as an ideal frequency for the BPIPs?

Monthly—50%

Quarterly—29%

Bimonthly—21%

Here are some benefits from the HHQI Campaign as identified by a few of the survey participants:

- Networking with other agencies
- The HHQI reports
- Resources, which were practical and standardized, yet modifiable
- CEU opportunities

How many survey participants could access, locate and download/print information from the HHQI Web site (www.homehealthquality.org)?

98%

How many survey participants would consider participation in a future quality improvement national initiative?

96%

What topics did survey participants identify a need for educational packages and/or resources in the future?

Wounds—93%

Diabetes—83

Here are a few other future topics identified by the agencies (and where you may find some help in the HHQI Best Practice Intervention Packages (BPIPs) and associated resources—links included if appropriate):

CHF (Disease Management BPIP—Nurse Track, Polish Your Practice for CHF)
CVA
Cancer
Use of rehabilitation/Therapy (Each BPIP has a Therapy Track)
HTN
Cardiac topics
Asthma
Renal disease
Urinary incontinence
Intravenous/infusion therapy
Pneumonia
Pediatrics
OASIS accuracy and coding
Ostomies
Communication of disciplines (Physician Relationship BPIP contained SBAR guide for communication to other disciplines—included in each discipline track)
Alzheimer’s
Health Coaching Techniques (Patient Self-Management BPIP, including the video from California Health Care Foundation, Effective Techniques for Patient Self-Management Video by California Healthcare Foundation)
Cultural Differences
Safety (Fall Prevention BPIP)
More on Phone Triage (Along with the Teletriage BPIP, the Home Telehealth Reference 2006/2007 –focus on teletriage)
Anticoagulation Therapy
Medication management—high-risk medications (Beer’s Criteria—included as STEPS to MEDICATION SIMPLIFICATION)
Specific disease management (Disease Management BPIP—Polish Your Practice for CHF and COPD)
Pain management
End of life issues/hospice focus
PPS

Here are some additional comments from the agencies that participated in the survey and remarks from the HHQI staff.

While all the tools and training has been very helpful, we have not had the time to implement and utilize in all areas. Sometimes the staff has felt quite overwhelmed with all the material, couldn’t keep up. Maybe materials could be presented on a less frequent basis, allowing time to implement, improve and evaluate in one area, before introducing the next.

Thanks! We appreciate this comment and, many times have felt as overwhelmed as the home health agencies. Also—you aren’t alone; many agencies expressed frustration with the monthly frequency. * We recognize that monthly was overwhelming, but knew that each of the identified interventions was important in the effort of reducing acute care hospitalization. This was only a 12-month campaign, so we decided on the monthly schedule. Please know that the packages may be implemented on a timeline that is more acceptable and feasible for your agency. We recommend that you download the resources now and save them for a time that your agency can implement the interventions.

(*Although 50% of the survey participants liked the monthly frequency!)

We found the information very informative. The best practices were coming in faster than we could implement, however, we were able to continue on at our own pace without getting frustrated. We will continue to use all the information in 2008 to improve our outcomes and to have a great successful year!

Wonderful! You’ve got it!!

Please don’t stop-we have become dependent upon this regular source of up to the minute best practice materials.

Unfortunately, we must stop! However, the campaign resources will remain available on the HHQI Web site (www.homehealthquality.org) and will also be available on www.medqic.org. There are enough resources and tools available in the BPIPs to keep agencies engaged for some time! As noted in question 17 there are many topics that still need resources. We’ll keep everyone’s input for future endeavors.

With the high staff turnover, we would like to schedule a one on one in-service training with a HHQI resource person.

Consider contacting your LANE directly. The state Quality Improvement Organization and most state associations have worked closely with the HHQI staff on this campaign.

I would like to see more suggestions for small agencies, and for agencies that have staff that can be resistant to change.

The HHQI resources were designed for all agencies. We realize both small and large agencies have unique needs. Each BPIP contains an agency self-assessment and action plan. There are assessments and actions for small and large agencies. Consider looking at how some of the interventions were used in the Examples of Excellence (success stories). Both small and large agencies are represented.

We would like to have the ability to use the PowerPoint presentations that are in the WebEx presentations.

All of the WebEx presentations had the PowerPoint presentation and handouts posted along with the WebEx. Feel free to use these. Look for these on the Web page of each specific best practice.

In a small agency, with only four RNs, one of whom is the Director, it is so very difficult to find time to study, analyze, implement and evaluate these excellent modules. How do others make the time??

We understand—there has been a vast amount of information in each package. Janet Lane, the Illinois LANE (QIO) representative, expresses it well when she says, "Choose What You Can Use". There is no way any agency can use everything in the package, and trying to decide what to use may certainly prove challenging! Having a team review and select what resources are most appropriate is a start. (A team can consist of only 2—team size would vary based on agency size.) This can be done at a meeting or even with a checklist while circulating the package. Carefully select what is most appropriate for your agency and start small! More can be added later.
The resources can be adapted and modified to best fit with your agency staff and client population.

This entire campaign is difficult when 95% of an agency's caseload are elderly > than age 80. Improvement is not seen often in this age group, but rather maintaining is a success.

Maintaining can be a success! Don’t forget the goal is to reduce avoidable acute care hospitalizations whether the patient is 65 or 105. Many of the resources are designed specifically for geriatric patients—for example the Beer’s Criteria (2002 Criteria for Potentially Inappropriate Medication Use in Older Adults: Independent of Diagnoses or Conditions).Take a look at the Fall Prevention BPIP,which is focused on preventing fallscertainly a part of maintaining! Additionally the Immunization BPIP contains a crosswalk to the Immunization Toolkit, which has many references showing the importance of influenza and pneumococcal immunization in the elderly. (Reference page 16 of the Immunization Toolkit)

Is there any chance to access information that would have been previously sent and utilize it?
We have had a near total turnover of our staff including management.

All the information that has been posted as part of the HHQI National Campaign will continue to be available and exists in the public domain. All resources are currently posted on www.homehealthquality.org and on www.medqic.org

I feel the Campaign is truly interested in the best possible care be provided to Home Care Clientele. I feel there has been a great deal of work and research put into this Campaign and am appreciative of the effort.

Thanks for reinforcing what the campaign is all about. Taking care of the patient and providing the highest quality care possible is the objective for every home care staff member, QIO, state association and the HHQI staff!

And finally…
The nurses were grateful for information they received and utilized some of it. This campaign forced us to focus on an initiative and implement methods to improve the situation. We are starting to see better results and plan to continue our focus on the initiative after the program ends and until we reach our goal!

Keep up the great work! Thanks to every HHQI participating agency for your dedication and commitment!

Agency Question/Comment	HHQI Response
Have the data come a little closer to real time data (not 5 months behind).	Note that the 1st page of the report is concurrent with the OBQI reports from the CASPER system, which are always 2.5 months behind real-time. This is to ensure that the data reflects all OASIS assessments for each 12-month period. The 2nd page of the report does contain OASIS data that is one month more recent than the OBQI reports (e.g., the HHQI reports your agency receives in January 2008 would include OASIS data from November 2007.) The 2nd page of the report contains data that is not risk adjusted, but provides more current information to your agency.
It would be helpful to have the top 20% numbers for the state as well as nation.	The Statewide 10th and 20th Percentile Rates are included on the 1st page of the report.
Quality of print not the best, could they be emailed directly to the agency?	These reports have to be mailed through the US Postal Service because they contain confidential information. E-mail is not a suggested vehicle to carry confidential information.
Can you report by diagnosis?	Unfortunately, no. The OASIS data is based only on discharge assessments, not Start/Resumption of Care assessments. This means that we can only identify hospitalizations by Reason for Hospitalization, which is identified in M0895 (2nd page of the report).
I would like more one on one direction of how we can use this information with staff and other leaders in the organization to help our cause.	Direction on how to use the report is posted on http://www.homehealthquality.org/hh/hha/faqs/reports.aspx Additionallyyour state QIO can help you understand how to review and better utilize the reports.
The data is very beneficial in helping us make the decision for weekly calls to patients with HF.	A great example of linking the data on the HHQI reports to a proactive intervention!
This is the most valuable part of the program for us.	Thanks! We received several requests to continue the reports. Based on this feedback, we will continue to provide the reports to each state’s Quality Improvement Organization (QIO) through July 31, 2008.

Here are some additional comments from the agencies that participated in the survey and remarks from the HHQI staff.
While all the tools and training has been very helpful, we have not had the time to implement and utilize in all areas. Sometimes the staff has felt quite overwhelmed with all the material, couldn’t keep up. Maybe materials could be presented on a less frequent basis, allowing time to implement, improve and evaluate in one area, before introducing the next.	Thanks! We appreciate this comment and, many times have felt as overwhelmed as the home health agencies. Also—you aren’t alone; many agencies expressed frustration with the monthly frequency. * We recognize that monthly was overwhelming, but knew that each of the identified interventions was important in the effort of reducing acute care hospitalization. This was only a 12-month campaign, so we decided on the monthly schedule. Please know that the packages may be implemented on a timeline that is more acceptable and feasible for your agency. We recommend that you download the resources now and save them for a time that your agency can implement the interventions. (*Although 50% of the survey participants liked the monthly frequency!)
We found the information very informative. The best practices were coming in faster than we could implement, however, we were able to continue on at our own pace without getting frustrated. We will continue to use all the information in 2008 to improve our outcomes and to have a great successful year!	Wonderful! You’ve got it!!
Please don’t stop-we have become dependent upon this regular source of up to the minute best practice materials.	Unfortunately, we must stop! However, the campaign resources will remain available on the HHQI Web site (www.homehealthquality.org) and will also be available on www.medqic.org. There are enough resources and tools available in the BPIPs to keep agencies engaged for some time! As noted in question 17 there are many topics that still need resources. We’ll keep everyone’s input for future endeavors.
With the high staff turnover, we would like to schedule a one on one in-service training with a HHQI resource person.	Consider contacting your LANE directly. The state Quality Improvement Organization and most state associations have worked closely with the HHQI staff on this campaign.
I would like to see more suggestions for small agencies, and for agencies that have staff that can be resistant to change.	The HHQI resources were designed for all agencies. We realize both small and large agencies have unique needs. Each BPIP contains an agency self-assessment and action plan. There are assessments and actions for small and large agencies. Consider looking at how some of the interventions were used in the Examples of Excellence (success stories). Both small and large agencies are represented.
We would like to have the ability to use the PowerPoint presentations that are in the WebEx presentations.	All of the WebEx presentations had the PowerPoint presentation and handouts posted along with the WebEx. Feel free to use these. Look for these on the Web page of each specific best practice.
In a small agency, with only four RNs, one of whom is the Director, it is so very difficult to find time to study, analyze, implement and evaluate these excellent modules. How do others make the time??	We understand—there has been a vast amount of information in each package. Janet Lane, the Illinois LANE (QIO) representative, expresses it well when she says, "Choose What You Can Use". There is no way any agency can use everything in the package, and trying to decide what to use may certainly prove challenging! Having a team review and select what resources are most appropriate is a start. (A team can consist of only 2—team size would vary based on agency size.) This can be done at a meeting or even with a checklist while circulating the package. Carefully select what is most appropriate for your agency and start small! More can be added later. The resources can be adapted and modified to best fit with your agency staff and client population.
This entire campaign is difficult when 95% of an agency's caseload are elderly > than age 80. Improvement is not seen often in this age group, but rather maintaining is a success.	Maintaining can be a success! Don’t forget the goal is to reduce avoidable acute care hospitalizations whether the patient is 65 or 105. Many of the resources are designed specifically for geriatric patients—for example the Beer’s Criteria (2002 Criteria for Potentially Inappropriate Medication Use in Older Adults: Independent of Diagnoses or Conditions).Take a look at the Fall Prevention BPIP,which is focused on preventing fallscertainly a part of maintaining! Additionally the Immunization BPIP contains a crosswalk to the Immunization Toolkit, which has many references showing the importance of influenza and pneumococcal immunization in the elderly. (Reference page 16 of the Immunization Toolkit)
Is there any chance to access information that would have been previously sent and utilize it? We have had a near total turnover of our staff including management.	All the information that has been posted as part of the HHQI National Campaign will continue to be available and exists in the public domain. All resources are currently posted on www.homehealthquality.org and on www.medqic.org
I feel the Campaign is truly interested in the best possible care be provided to Home Care Clientele. I feel there has been a great deal of work and research put into this Campaign and am appreciative of the effort.	Thanks for reinforcing what the campaign is all about. Taking care of the patient and providing the highest quality care possible is the objective for every home care staff member, QIO, state association and the HHQI staff!
And finally… The nurses were grateful for information they received and utilized some of it. This campaign forced us to focus on an initiative and implement methods to improve the situation. We are starting to see better results and plan to continue our focus on the initiative after the program ends and until we reach our goal!	Keep up the great work! Thanks to every HHQI participating agency for your dedication and commitment!

Home Health Quality Improvement