Outcomes Report through September 2013 Lieberman Center for Health & Rehabilitation
Contents Overall Outcomes for Rehabilitation .............................................................. 3 Sub-Acute Rehospitalizations within 72 Hours ................................................ 4 Rehospitalization Rates within 30 Days ........................................................... 5 72-Hour and 30-Day Rehospitalization Rates .................................................. 5 Long Term Care Unplanned Hospitalizations .................................................. 6 Fall Rates ......................................................................................................... 7 Major & Minor Injury Rates .......................................................................... 7-8 House-Acquired Pressure Ulcer Prevalence Rates .......................................... 8 Nosocomial Infection Rates ............................................................................. 9 Nosocomial Urinary Tract Infection Rates ....................................................... 9 Multi-Drug Resistant Organisims Rates ......................................................... 10
2
INTRODUCTION We are pleased to present the following Outcomes Report for Lieberman Center for Health and Rehabilitation (LCHR). This report is current through the third 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 Center for Heart Health Program; skilled nursing, including, but not limited to, hemodialysis, 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 credentialed 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, nephrologist, 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 2011 Through September 2013 7 6 5 4 3 2 1 0 1st Quarter 2011
2nd Quarter 2011
3rd Quarter 2011
4th Quarter 2011
1st Quarter 2012
***Avg. Overall Pre-Morbid*** Avg. Overall Pre-Morbid*
2nd Quarter 2012
3rd Quarter 2012
Avg. Overall at Admit
4th Quarter 2012
1st Quarter 2013
2nd Quarter 2013
3rd Quarter 2013
Avg. Overall at Discharge
*(This is a subjective measure, based on the patient’s report of their functional ability prior to entering the hospital.)
3
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 Rehospitalization Rates within 72 hours through September 2013
18% 16%
17%
15%
14% 12%
10%
10% 8% 6% 4% 2%
7% 6%
5% 4% 3%
3%
0% 1st Quarter
0%
2%
2nd Quarter
3rd Quarter
2011
7% 5%
5% 4%
4%
4th Quarter
2010
2012 2013
Annual average rate
4
LCHR Sub-Acute Rehospitalization Rates within 30 days through September 2013 35%
31%
30% 25% 20%
27%
25%
26% 24%
17%
17%
15% 10%
15%
20% 18%
17%
14%
15%
14%
18%
2010
16%
2011 2012 2013
5% 0% 1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Annual average rate
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).
LCHR Annual Mean Percent for Rehospitalizations within 72 hours and 30 days through September 2013 0.3 0.25
26%
0.2 18%
0.15
16%
5%
72 Hours 30 Days
10%
0.1 0.05
18%
4%
3%
0 2010
2011
2012
2013 Thru 3rd Quarter
5
Long Term Care Unit Unplanned Hospitalization Rates 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.
Rate is per 1000 Patient Days
LCHR Long Term Care Unit Unplanned Hospitalizations through September 2013 5
4
3 2012 2
1
1.6 1.3
1
2
2013
1.6
1.5 1.3
6
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-drugresistant organisms. 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 September 2013
Rate per 1000 Patient Days
19 15.8
17 15 13
14.1 12.5 10
11 9
7.8
8.3
8.1
7
7 7.3
5
6.5
3
10.3
10.5 7.8
5.8
6
5.7
House LTC Sub-Acute
5.2
5.3
5.2
2011
2012
2013 through 3rd qtr.
1 2007
2008
2009
2010
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).
7
Injury Rates per 100 Falls
LCHR Annual Mean Rate of Major & Minor Injury 2007 through September 2013 18 16 14 12 10 8 6 4 2 0
15.8
14.8 11.5
12.7 10.6 10.6
Major
9 7
Minor 0.7
4 3
2.9
2006
2007
2.5 2008
2009
2.6 2010
2.2
2.2 2011
2012
2013 through 3rd qtr.
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. Annual Mean Rate for House-Acquired Pressure Ulcers from 2007 through September 2013 Note: Data is for each pressure ulcer, not each patient who acquired a pressure ulcer
Rate per 1000 Patient Days
3.5
3.1
3 2.5
2.8
3.1
2.8 2.4
2
3.1
1.8
2.1 House
1.4
1.5
1.5
1
1.8
0.5
1.3 0.6
1.2
LTC
0.8
Sub-Acute
0.7
0 2007
2008
2009
2010
2011
2012
2013 through 3rd qtr.
8
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.
Nosocomial Infection Rate through September 2013 Rate per 1000 Patient Days
Note: Method for Aggregating Data Evolved after 2008 10 9 8 7 6 5 4 3 2 1 0
8.9 8 7.5 5.7
7.8 5.7
7.3
6.6 6.1
6
5.8
5.5
6.3
5.3
5.2 5.1 4.8
Whole House LTC Sub-Acute Unit
2007
2008
2009
2010
2011
2012
2013 through 3rd qtr.
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 through September 2013 Note 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
3.9
3.7 2.8
2.4
2.2 2.5
2 2.1
2.1
3.3 2.3 2
2.2 2.1 2
Whole House LTC Sub-Acute Unit
1 0 2007
2008
2009
2010
2011
2012
2013 through 3rd qtr.
9
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 SubAcute Unit with the majority present on admission.
Multidrug Resistant Organisms Annual Mean of Prevalence Rates (VRE, MRSA, ESBL, C-Diff) through September 2013 (Period used = one month) 5
Rate per 1000 Patient Days
4.5
4.1
4 3.5
3.3
4.3 3.6
2.6
3 2.5
House
2 1.5
LTC 1.4 1
1 0.5
0.7
0 2009
0.8
0.9
1
0.7
0.3
STU
0.9 0.4 2010
2011
2012
2013 through 3rd qtr.
10
11
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. 10.2013
12