Lieberman Center for Health & Rehabilitation Outcomes report thru quarter 1 2013 mk

Outcomes Report through March 2013 Lieberman Center for Health & Rehabilitation

Contents Overall Outcomes for Rehabilitaton ............................................................... 3 Sub‐Acute Rehospitalizations within 72 Hours ................................................ 4 Rehospitalization Rates within 30 Days ........................................................... 5 72‐Hour and 30‐Day Rehospitalization Rates .................................................. 5 30‐Day Rehospitalization Rates for NSUHS Hospitals ...................................... 6 30‐Day Rehospitalization Rates for Skokie Hospital ........................................ 6 Long Term Care Unplanned Hospitalizations .................................................. 7 Fall Rates ......................................................................................................... 8 Major & Minor Injury Rates ............................................................................. 8 House‐Acquired Pressure Ulcer Prevalence Rates .......................................... 9 Nosocomial Infection Rates ........................................................................... 10 Nosocomial Urinary Tract Infection Rates ..................................................... 10 Multi‐Drug Resistant Organisims Rates ......................................................... 11

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INTRODUCTION We are pleased to present the following Outcomes Report for Lieberman Center for Health and Rehabilitation (LCHR). This report is current through the first quarter of 2013 and consists of outcomes directly related to patient care. The data is specific to three areas: the Haag Pavilion (Sub‐Acute Unit), Long Term Care Unit (all floors as one unit) and the Whole House (the entire facility).

Haag Pavilion (Sub‐Acute Unit) The Haag Pavilion offers these services with specialized staff: skilled therapy (occupational, physical and speech); a dedicated Heart Health Program; skilled nursing, including, but not limited to, infusion therapy and wound care. The staff consists of the following: specially trained RNs; a full time staff nurse practitioner; physical, occupational and speech therapists; and social services staff. There are crendentialled medical consultants who round weekly or see patients more often, depending upon need. The consultant staff consists of a physiatrist, a wound physician, a cardiologist, psychiatrists and a neuro‐psychologist. Coordination of care and communication among all disciplines on the Unit is managed by the Clinical Nurse Manager, a certified rehabilitation nurse.

Rehabilitation Outcomes The Therapy Department works primarily on a patient’s functional status. Efforts are directed at increasing strength, endurance, and balance. The three prime areas that are measured are transferring/toileting; dressing; and ambulation. This data is then used to determine a patient’s overall outcomes for improvement in functional ability from their status from pre‐hospitalization to discharge.

LCHR Overall Outcomes for Rehab 2010 Through Q1 2013 7

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6 5 4 3

2 1 0 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter Quarter 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2010

2010 2010 2010 2011 ***Avg. Overall Pre‐Morbid*** Avg. Overall Pre‐Morbid*

2011 2011 2011 2012 2012 2012 2012 Avg. Overall at Admit Avg. Overall at Discharge

2013

*(This is a subjective measure, based on the patient's report of their functional ability prior to entering the hospital.)

Functionality Key 7 = Independent, no assistance required 6 = Supervision, short-term, home health recommended 5 = Stand-by assistance, personal care recommended 2 days per week for 2 or more hours

4 = Contact guard assistance, personal care recommended 3 days per week for 2 or more hours 3 = Minimal assistance of 25-49%, 20 hours per week of personal care recommended 2 = Moderate assistance of 50-74%, 40 hours per week of personal care recommended 1 = Maximum assistance of 75-90%, live-in assistance recommended or skilled facility

0 = Totally dependent

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The initial data point on the chart is the patient’s pre‐morbid state, or how the patient functioned prior to his/her recent illness. It is a self reported parameter and is determined through interview with the patient and/or the patient’s family/significant other. The second data point is determined by the physical therapist at the time of the initial assessment which is performed within 24 hours of admission to the Haag Pavilion. The final data point is determined by the skilled therapist at the time of discharge.

Note that the patient’s status is measured with “FIMS” a standardized functional measurement tool with a scale of 0 to 7, where 0 = most dependent and 7 = independent (see Key, page 3). The average overall improved functional ability was 1 to 2 points on this scale.

Rehospitalization Outcomes of Sub‐Acute Patients Below are three charts, the first with the 72‐hour rehospitalization rate; the second with the 30‐day rehospitalization rate. The third shows the annual rates for both 72 hour and 30 day rehospitalizations.

It should be noted these rates are not risk adjusted.

LCHR Sub‐Acute Rehospitalizations within 72 Hours Note: Q1 2013 Rate = 6% 20%

2010

15% 10%

10%

5%

4%

0%

5%

2011 2012 2013

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Average Annual Annual

Q1 Q2 Q3 Q4 average rate Rate

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LCHR Rehospitalization Rates within 30 Days Note: Q1 2013 Rate = 17% 35% 30% 26%

25%

2010

20%

18% 18%

15%

2011 2012

10%

2013

5% 0% 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Annual average rate

LCHR Average Annual 72‐hour and 30‐day Rehospitalization Rates 30% 25%

26% 18%

20%

18% 17%

15% 10% 5%

72 Hours

10%

30 Days

4%

6%

2012

2013 1st Q1 2013 Quarter

5%

0% 2010

2011

Note: The national norm for rehospitalization is 26%. The average national rate for the 30‐day readmission rate for the Medicare A SNF benefit is 21.04% (as reported by the Illinois Quality Improvement Organization).

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Rehospitalization Outcomes for our Patients Admitted from NorthShore University HealthSystem Hospitals

The following two charts contain data regarding rehospitalization rates specific to Lieberman Center and the NorthShore University HealthSystem (NSUHS). The first chart represents the rehospitalization rate for the four hospitals within the System. The second chart is for Skokie Hospital, which is the primary referral source for sub‐acute patients to Haag Pavilion. The rates are not risk adjusted.

LCHR 30‐Day Rehospitalization Rates for NSUHS Hospitals: Evanston, Glenbrook, Highland Park & Skokie Note: Q1 2013 Rate = 18% 21% 20%

20% 19%

19%

18%

18%

2012 2013

17% 17%

17%

16% 15%

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Average Annual Annual Rate

LCHR 30‐Day Rehospitalization Rates for Skokie Hospital Note: Q1 2013 Rate = 8% 30% 25% 20% 15%

19%

20%

18% 17%

2012

17%

2013

10% 5% 0%

Q1 Q2 Q3 Q4 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Average Annual AnnualRate

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Long Term Care Unit Unplanned Hospitalization Rates

Rate is per 1000 Patient Days

Data has been collected for unplanned hospitalizations for the long term care floors of the facility. They are considered as the Long Term Care Unit for the purposes of this report. These rates are calculated per 1000 patient days and are not risk adjusted.

LCHR Long Term Care Unit Unplanned Hospitalizations Note: Q1 2013 Rate = 1 5 4 3 2 1

2 1

2

1

2012 1.5

2013

Q1 Q2 Q3 Q4 Average Annual Annual Average Rate Rate

Health Services (Nursing) Outcomes The data and charts that follow reflect outcomes in the following clinical areas: falls, major and minor injuries associated with falls, house‐acquired pressure ulcers, urinary tract infections and multi‐drug‐ resistant organisms.

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Falls The fall rate is calculated per 1000 patient days. A stringent criterion of how falls are counted has been employed. For example, if an individual is “eased” to the floor, that situation is considered a fall. More in depth investigation has identified a number of challenges associated with Lieberman’s fall rates.

These are: the facility’s strict restraint‐free policy; the age demographics of the Lieberman population30% of the residents are between the ages of 75 to 84, and 40% are 85 years old or older; and the acute confusional delirium often associated with hospitalization and transition to a sub‐acute unit.

LCHR Annual Mean Rate for Falls 2007 through March 2013 19 Rate per 1000 Patient Days

17

15.8

15

14.1

13 11

12.5 8.3

9 7 5

10 8.1 7

7.8 6.1

6.9

7.3

11.7 10.3

10.3

5.8

6

LTC STU

6.7

6.5

3

7.7

House

5.2

5.3

2011

2012

1 2007

2008

2009

2010

Thru March Thru April 2013 2013

Fall‐related Injuries The major reasons for tracking these statistics are two‐fold: 1) fall‐related injuries are a serious health issue for the elderly population; and 2) they are an indication of the effectiveness of patient‐specific fall prevention interventions that reduce risk and prevent or minimize falls and fall‐related injuries.

Injuries are first classified as major (e.g. fracture, subdural hematoma) or minor (e.g. bruise, skin tear).

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Injury Rates per 100 Falls

LCHR Annual Mean Rate of Major & Minor Injury 2007 through March 2013

20

20

15

15

10

10

5

5

0

0

12.7 10.6

10.7

9 7

3

2006

14.8

2.9 2007

2.5

2.6

11.5 2.2

4 2008

2009

2010

2011

0.7

Major 1.3

Minor

2012 Thru March Thru 2013 April 2013

House‐acquired Pressure Ulcers Lieberman’s skin management program includes protocols for prevention, treatment, and pain assessment and management. The nursing staff is augmented by a board certified podiatric surgeon and a wound specialty surgeon, who make weekly rounds and are active members of the wound management team. It is Lieberman’s practice to count each pressure ulcer rather than each resident who has one or more pressure ulcers. This is a considerably more stringent method of data collection as compared to the CMS Quality Measures that report a percent of residents with pressure ulcers.

LCHR Annual Mean Rate for Prevalence Rate for House‐ Acquired Pressure Ulcers from 2007 through March 2013

Rate per 1000 Patient Days

Data is for each pressure ulcer, not each patient who acquired a pressure ulcer.

3.5 3 2.5

2.8

3.1

2.4 House

2.1

2 LTC

1.5 1.5

1

1.3

STU

0.7

0.5 1.3

0 2007

2008

2009

2010

2011

2012

Thru March Thru April 2013 2013

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House‐acquired Infections Lieberman has used control charts for monitoring infection rates from a Whole House perspective since 2007. In 2007 the Sub‐Acute Unit expanded to include the entire fourth floor. Surveillance activities in 2007 and 2008 suggested that there was an increased incidence of infection in the Sub‐ Acute‐Unit. This observation prompted the calculation and tracking of the nosocomial (house acquired) rate for the Sub‐Acute Unit and the Long Term Care floors as a combined unit, as well as the Whole House. This was started in 2009.

Rate per 1000 Patient Days

LCHR Nosocomial Infection Rate Method for Aggregating Data Evolved after 2008 10 9

8.9 8

8 7.5

7.8 6.1

5.7

6

5.7

6.3

5.3

5

7.3

6.6

7

5.8

6

6.3 5.5

4 2007

2008

2009

2010

2011

7.7

2012

Whole House House

LTC STU

Thru March Thru 2013 April 2013

House‐acquired Urinary Tract Infections Symptomatic urinary tract infections (UTIs) are the most common infection experienced by residents of Long‐Term Care facilities. Because of this, the nosocomial UTI rates are tracked for each floor. It was not until after the Sub‐Acute Unit was expanded to the entire fourth floor that the UTI rate for the Long‐Term Care floors was calculated as one unit.

Nosocomial UTI Rate Method of Aggregating Data Evolved after 2008

Rate per 1000 Patient Days

6 5 4 3

4.8

4.1

4.3 3.4 3

2.4

2

3.7

3.9

2.1

2.8 2.5

3.3

2.2

2.3

2.1

2

3.3 2.7 2.3

House Whole House LTC STU

1 0 2007

2008

2009

2010

2011

2012

Thru March Thru 2013 April 2013

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Multi‐Drug Resistant Organisms In 2007 multi‐drug resistant organisms were tracked for each floor in the facility. After a full year’s data was aggregated it was determined that, because the rates were so low, the methodology of using point prevalence should be changed to period prevalence (using one month as the period). This was done in 2008. In 2009, since the rates continued to remain very low for all of the Long Term Care floors, it was determined that it would be more informative to combine the numbers for these units. The higher prevalence rates exist in the Sub‐ Acute Unit with the majority present on admission.

Rate per 1000 Patient Days

LCHR Multi‐Drug Resistant Organisms Annual Mean of Prevalence Rates (Period used = one month) 6 4.3

5 4.3

4 3.3

House

3.6

3

LTC

2.6

STU

2 1

1 0.7

0 2009

0.8

1.4 0.9

0.4 2010

2011

0.9 0.8 2012

0.6 0 Thru March Thru April 2013 2013

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Lieberman Center for Health and Rehabilitation 9700 Gross Point Road, Skokie, IL 60076 847.929.3320 www.cje.net

CJE SeniorLife is a partner in serving our community, supported by the Jewish United fund/Jewish Federation of Metropolitan Chicago.

6.2013

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