Outcomes Report through Third Quarter 2014
Lieberman Center for Health & Rehabilitation
Contents
Introduction ...............................................................................................................................................3 Haag Pavilion (Sub-Acute Unit) ...................................................................................................................3 Rehabilitation Outcomes ............................................................................................................................3 Rehospitalization Outcomes of Sub-Acute Patients .....................................................................................4 Long Term Care Unit Unplanned Hospitalization Rates ................................................................................5 Center for Heart Health Outcomes ............................................................................................................6 Health Services (Nursing) Outcomes ...........................................................................................................7 Fall-related Injuries ....................................................................................................................................7 House-Acquired Pressure Ulcers .................................................................................................................8 House-Acquired/Nosocomial Infections ......................................................................................................8 House-acquired/Nosocomial Urinary Tract Infections ..................................................................................9 Multi-Drug Resistant Organisms .................................................................................................................9
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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 third quarter of 2014 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) and the Whole House (the entire facility).
Haag Pavilion (Sub-Acute Unit) The Haag Pavilion offers these services with specialized staff: skilled rehabilitation therapy; a dedicated Center for Heart Health; skilled nursing, including, but not limited to, hemodialysis, peritoneal dialysis, 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 medical staff consists of the following specialties: physiatry, cardiology, nephrology, infectious disease, psychiatry, neuropsychology, and wound care. 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 areas that are measured are transferring/ toileting; dressing; and ambulation. Data is then used to determine a patient’s overall outcomes for improvement in functional ability from their admission status to their status at the time of discharge. Lieberman Center for Health & Rehabilitation Overall Outcomes for Rehab 6 5 4 3 2 1 0 1st Quarter 2013
2nd Quarter 2013
3rd Quarter 2013
Average Admit FIM Score
Functionality Key
4th 1st Quarter 2nd Quarter 2014 Quarter 2013 2014
3rd Quarter 2014
Avgerage Average Discharge FIM Score
7 = Independent, no assistance required 6 = Supervision, short-term, home health recommended 5 = Stand-by assistance, personal care assistance recommended for 2 days a week for 2 or more hours 4 = Contact Guard assistance, personal care recommended 3 days a week for 2 or more hours 3 = Minimal assistance of 25-49%, 20 hours/week personal care recommended 2 = Moderate assistance of 50-74%, 40 hours a week of personal care recommended 1 = Maximum assistance of 75-90%, live-in assistance recommended or skilled facility 0 = Totally dependent
Note: The first data point is determined by the therapist at time of the initial assessment, which is performed within 24 hours of admission to the Haag Pavilion. The second data point is determined by the skilled therapist at time of discharge. The patient’s status is measured with Functional Independence Measures (FIM) a standardized functional measurement tool with a scale of 0 to 7, where 0 = most dependent and 7 = independent (see Key, above). The average overall improved functional ability was 1 to 2 points on this scale.
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Rehospitalization Outcomes of Sub-Acute Patients Below are three charts, the first two charts represent the quarterly 72-hour and the 30-day rehospitalization rates respectively. The third chart depicts the annual rates for both 72 hour and 30 day rehospitalizations. It should be noted these rates are not risk-adjusted.
Lieberman Center for Health & Rehabilitation 72 Hour Rehospitalization Rates 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0%
9% 6% 4% 3% 2% 0%
2013 3%
2014
1%
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
Annual average rate
Lieberman Center for Health & Rehabilitation Lieaberman 30 Day Rehospitalization Rates 25% 20% 15%
19% 17%
21% 14%
18% 15%
19% 17% 2013
10%
2014
5% 0% 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
Annual average rate
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Lieberman Center for Health & Rehabilitation Annual Mean Percent for Rehospitalizations 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%
18%
17%
72 Hours 30 Days 5% 3% 2014 thru 3rd Quarter 1/4 Quarter
2013
Notes: The national norm for 30 day 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). The comparable rate for sub-acute stays for the Lieberman Center was 17% in 2013 and was 20% through the third quarter of 2014.
Long Term Care Unit Unplanned Hospitalization Rates Data has been collected for unplanned hospitalizations from the long term care floors of Lieberman Center. 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. For the past two years the rate has remained between 1 and 2 with the average between 1.5 & 1.7.
Rate is per 1000 Patient Days
Lieberman Center for Health & Rehabilitation Unplanned LTC Hospitalizations 3 2
2
2
2
2 1.7
2 1
1 1
2013
1
2014
1 0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
Average Annual Rate
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Center for Heart Health Outcomes In February 2013 the Center for Heart Health dedicated to cardiac patients was established at the Haag Pavilion. Dr. Caesar A. De Leo, a NorthShore University HealthSystem cardiologist, is the lead consulting physician for the Program. Additional training was given to the nursing department, and additional equipment was purchased. Initially patients considered for this unit had a primary cardiac diagnosis. After the first year as patients were screened for statistical purposes, it was discerned that a close look at co-morbidities was required. It was observed that cardiac co-morbidities were frequently exacerbated due to the recent acute hospitalization, thus necessitating increased assessment and management. It was determined that patients with a cardiac co-morbidity should be included if the exacerbation was identified by the hospital as an active diagnosis during the hospitalization prior to the admission to LCHR. The following statistics have been aggregated since the opening of the unit in February 2013.
Lieberman Center for Heart Health
Note: Rehospitalization Rates are calculated for patients admitted for related cardiac issues. 100 90 80 70 60 50 40 30 20 10 0
92
83 83 73 66
52
2013 Feb. thru Dec.
28 26 12 2
2
1
2014 thru 3rd Quarter
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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, house-acquired infections and urinary tract infections and the prevalence of multi-drug-resistant organisms.
Falls
Rates per 1000 Patinet Days
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. The improvement process which LCHR has implemented continues to evolve. It is primarily centered on inter-disciplinary assessment and individualized interventions. Lieberman Center for Health & Rehabilitation Annual Mean Rate for Falls 10 8 6 4 2 0
7.5 8 5.3
4.8
4.7
House
2013
3.8
LTC
2014 thru 3rd Quarter Sub-Acute
Fall-related Injuries
Rate per 1000 Patient Days
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). It should be noted that this rate is calculated per 100 falls rather than on 1000 patient days which is the methodology for all other rates calculated for Health Services (Nursing). Lieberman Center for Health & Rehabilitation House Annual Mean rate of Major & Minor Injuries 20 14.4
15 10 5 0
6.7 1.9
1.5 2013
Major Minor
2014 thru 3rd Quarter
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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.
Lieberman Center for Health & Rehabilitation Annual Mean Rate for House Acquired Pressure Ulcers Rate per 1000 Patient Days
Note: Data is for each pressure ulcer, not each patient who acquired a pressure ulcer
1.5 1
1.3
1.1 0.8
1.2 2013
0.7
0.5 0.1 0 House
LTC
2014 thru 3rd Quarter
Sub-Acute
House-Acquired/Nosocomial Infections
Rate per 1000 Patient Days
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.
5.3
5.5
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House-acquired/Nosocomial 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. Lieberman Center for Health & Rehabilitation Nosocomial UTI Rate Rate per 1000 Patient Days
3.5
2.5
3.2
3
3
2.3
2.2
2 2.1
2
2013
1.5
2014 thru 3rd Quarter
1 0.5 0 House
LTC
Sub-Acute
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.
Lieberman Center for Health & Rehabilitation Multidrug Resistant Organisms (VRE, MRSA, ESBL, C-Diff)
Rate perer 1000 Patient Days
Annual Mean of Prevalence Rates (Period used = one month)
6
5.6
5
4
4
2013
3 2 1
1
2014 thru 3rd Quarter
1 0.3 0.3
0 House
LTC
Sub-acute
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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. 01.2015
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