Optimizing Core Measures Performance through Concurrent Facilitation by Patient Care Analysts

Intervention Title:

Optimizing Core Measures Performance through Concurrent Facilitation by Patient Care Analysts– Montefiore Medical Center; Bronx, N.Y.

Goal:

Improve compliance on evidence-based performance measures for acute myocardial infarction (AMI) and heart failure (HF) throughconcurrent facilitation by quality improvement personnel.

Innovation:

Staff created new positions for quality improvement facilitators, called patient care analysts, to help providers improve their practice patterns and use of evidence-based interventions. These analysts perform reviews while patients are still in the hospital to verify that evidence-based care opportunities are optimized and that necessary documentation is completed.

Result:

Montefiore has seen significant improvements in compliance with key performance measures for AMI and HF patients. For example, rates of counseling (and documentation) for smoking cessation have increased dramatically from less than 50 percent to consistent rates of 100 percent.

Institution:

Montefiore Medical Center111 East 210th StreetBronx, NY 10467P: (718) 920-4321

From the C-Suite:

The patient care analysts at Montefiore have become a key component of our quality improvement efforts. The range of documentation requirements and best practices is so broad and constantly evolving that keeping up-to-date and ensuring compliance is a Herculean task. The analysts perform a key role in educating staff, optimizing patient care opportunities and responding to staff questions about various quality improvement mandates.

Rohit Bhalla, M.D., M.P.H.Chief Quality Officer

Profile:

Montefiore Medical Center is a 1,100+ bed not-for-profit academic medical center in The Bronx, N.Y.

Clinical areas affected:

  • Medical and cardiac inpatient units

Staff involved:

  • Frontline medical staff
  • Physicians
  • Physician assistants
  • Nurses
  • Quality improvement personnel
  • Medical directors

Timeline:

After receiving budgetary approval, the patient care analyst positions were filled expediently. Implementation of their role on units from planning to execution took approximately three months.

Contact:

Rohit Bhalla, M.D., M.P.H.Chief Quality OfficerP: (718) 920-7303rbhalla@montefiore.org

Innovation implementation:

The increase in mandatory reporting of quality performance measures has challenged hospitals to improve their compliance with evidence-based interventions. In order to increase success with the performance measures, frontline care staff need to understand measure requirements and take greater ownership of associated care processes in real time.

Montefiore Medical Center hired quality improvement personnel, called patient care analysts, to work with frontline providers to improve their practice patterns and use of evidence-based interventions. The analysts are responsible for reviewing patient care and records while the patient is still in the hospital. Through this concurrent facilitation, the analysts have an opportunity to verify that evidence-based care opportunities and pertinent documentation is complete before the patient leaves the hospital.

The analysts spend a significant proportion of their time in daily rounds on the medical and cardiac units, reviewing patient records. Once the analyst identifies a record where there may be a counseling, education or documentation opportunity, the analyst works with the appropriate physician or nurse one-on-one. Identifying the “failures” in real time gives staff and physicians the opportunity to comply with evidence-based standards and improve the hospital's performance on the AMI and HF measures. Montefiore attributes the increase in compliance on core measures related to AMI and HF smoking cessation and discharge instruction to the concurrent review interactions between the analysts and frontline staff. Following achievement of these gains, Montefiore is now considering the potential for these analysts to improve other aspects of care.

Advice and lessons learned:

  1. Documentation is a key driver of high-level performance.
  2. Identify unit champions.

Cost/benefit estimate:

As value-based purchasing and pay-for-performance programs expand in their scope and evolve to payment based upon actual performance results, an organization's return on investment for hiring patient care analysts will increase.This value is magnified when considering the potential revenue enhancement related to the analyst's role in documentation related to “present on admission” events, and the savings achieved by analysts by virtue of substituting one-on-one real time education for organization-wide training and educational efforts.

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