optimizing patient care pre-hospitalization
TRANSCRIPT
Comprehensive Care forJoint Replacement Model
Optimizing Patient Care Pre - Hospitalization
Comprehensive Care for Joint Replacement Model
June 19, 2019
Audio available through device speakers OR by dialing (800) 832 - 0736
Conference Room: *2657582# Access Code: 061919#
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Welcome
Alicia Goroski, MPH CJR Learning System Team
The Lewin Group
Laura Maynard, M.Div CJR Learning System Team
The Lewin Group
Lauren Nir, MPH CJR Learning System Team
The Lewin Group
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Webinar Agenda
• Welcome & Meeting Logistics
• NYU Winthrop Presentation
• Forbes Hospital Reaction
• Questions & Discussion
• Leaving in Action
• Announcements & Reminders
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Meeting Logistics
• All telephone lines are muted • We encourage comments, questions, and reactions via Chat
Disclaimer: The Center for Medicare & Medicaid Services (CMS), its employees, agents and staff assume no responsibility for any errors or omissions in the content of this webinar. CMS makes no guarantees of completeness, accuracy or reliability for any data contained or not contained herein. CMS shall not be held liable for any use of the information described and/or contained herein and assumes no responsibility for anyone's use of the information. CMS does not endorse any strategies, tactics, or vendors referred to in this webinar. The views and opinions expressed in this webinar are those of the participants and do not represent the official policy or position of CMS.
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Let’s Chat!
• Use the Chat pod to submit any questions or comments
• Please use “@” if your question/comment is directed to a specific presenter
• Submit your question/comment by clicking the chat bubble icon
• Please share in Chat now : – Organization – Location – A CJR improvement activity currently
in progress at your organization
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Where Are You Located?
To add yourself to the map: scroll to your location on the map, zoom in to your location, and drop the purple pin from the toolbar at your location • To Scroll: click and hold the mouse button to scroll the map left, right,
up, or down • To Zoom:
– use the mouse wheel or trackpad to move in; – double click; or – use the on screen zoom control (top right hand corner )
• Drag and drop the purple pin from the toolbar on the left to mark your location (the bottom of the pin should point to your location).
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Comprehensive Care forJoint Replacement Model
NYU Winthrop Hospital Presentation
Ellen Jordan, BSN, RNNurse Navigator, Transitional Level of Care
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Right Care, Right Time: Optimizing Patient Care Pre-Hospitalization
Ellen T. Jordan BSN, RN Orthopaedic Nurse Navigator Transitional Level of care Department of Orthopedics
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Right Patient, Right Time Optimizing Patient Care
Preoperatively
n NYU Winthrop Hospital n Suburb of NYC n 591 bed trauma designated hospital n 700 Total Joints annually n 300 Hip fractures
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BPCI through CJR
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Transitional Level of Care
n Nurse led TLC program n Initiated at home visit n Point of contact throughout 90 day
episode n Individualized plan of care n 20 years home care experience
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Coordinated Care Across the Continuum
Home Hospital Home
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Strong and Safe for Surgeryn Prehabilitation n Home Safety n Medication Management n RISK Stratification n Health Literacy n Optimization n Patient Centered Care n Patient Expectations
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Pre-hab
nPre - habilitation increased leg strength and the ability to perform functional tasks.
n4 - 8 weeks was effective for increasing strength and function for individuals with severe OA.
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Information Overload
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Home Exercise Program
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Home Safety
n Clear walkways n Adequate lighting n DME n Grab bars n Negotiating stairs n Bed transfers
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Medication ManagementPre - op Protocol
nTylenol
nLyrica
nCelebrex
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DVT Prophylaxis
nAspirinnAmbulation nAnkle Pumps
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Risk Stratificationn RISK stratification n Shared decision making n Project BOOST (Better Outcomes for
Older adults through safe Transitions)
n Project RED (Re - Engineered Discharge)
n NYS Transitional Level of care
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Risk Stratification
n Visits to ED n Polypharmacy n Recent falls n Access to transportation n Support system
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Support System!
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Health Literacyn Patients with low health literacy have
poorer health status, higher rates of hospital admission, are less likely to adhere to prescribed treatments and self care plans, experience more drug and treatment errors and make less use of preventive services.
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Health Literacyn OARS Model n 5-6th grade level n 14 point font n Bullets n Bold type
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Optimization
nBMI HgbA1cnMedical / Dental / Psych nERASnMRSA screening pre-operatively
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Case Presentationn JB 70 year old female n MI, CABG,DM, HTN, anemia, breast
cancer, anxiety disorder, urinary incontinence
n Family reports bipolar disorder n HHA 4 hours day n 3 family members in home
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Patient Centered Care & Patient Expectationsn Shared Decision Making n Discharge Disposition n What Matters Most n Expectation of pain n Medication management
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Patient Expectationsn “One of the largest drivers of patient
dissatisfaction with joint replacement is the uncertainty as to what to expect at all points along the care pathways”
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Right patient-right time
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Right patient-right time
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Right patient-right time
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Right patient-Right time
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THANK YOU!
“They may forget your name but they will never forget the way
you made them feel.”
Maya Angelou
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Poll 1
Do you conduct pre - operative home visits with your CJR patients? [Select one option] • Yes• No• I don’t know
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Questions & Answers
• Use the Chat pod to submit any questions
• Please use “@” if question is directed to aspecific presenter
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Poll 2
Do you have any strategies that you are willing to share with the CJR Learning System regarding optimizing patient care post-hospitalization? [Select one option] • Yes• No• Maybe
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Reaction
Elizabeth Trent, CMA (AAMA), AAS Orthopedic Navigator
Forbes Hospital
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Reflections & Discussion
• Use the Chat pod to submit any questions
• Please use “@” if question is directed to aspecific presenter
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Leaving in Action
• Please type into the Chat pod:– What new information have you identified today that you
will continue to think about and work on throughout thenext month?
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Announcements & Reminders
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Calling All Active Participant Hospitals!
• The deadline has been extended for the 2019 CJR Outreach and EducationNeeds Assessment Survey to Thursday, June 20th.
• The purpose of this survey is to:– Assess your hospital’s experience with implementing the CJR model;– Identify areas for CJR Learning System outreach and education; and– Identify ways in which your hospital would be willing to further engage in CJR LS
activities• We anticipate this survey will take no more than 20 minutes to complete.• If you have any questions about this survey, please email [email protected].• All survey responses will be reported in the aggregate and will not be
attributed to individual participant hospitals .
To begin the survey, click: https://www.surveymonkey.com/r/CJR2019.
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Continue Discussion on CJR Connect
• Join the Discussion! o Engage with your peers on CJR Connect by liking and commenting on their
posts • If you would like to ask a question of your peers or today’s speakers, you can:
o Go to the Groups tab, select “CJR All” and post your question in the group, OR
o Go to the Chatter tab, type a message into the open text box using the “Post to All” feature.
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Upcoming Events
Peer - Led Care Navigation Affinity Group Session 3
July 9, 2019 1:00 – 2:00 PM EDT
Using Data to Drive Improvement: Data Collection, Analysis, & Reporting Structure Webinar
July 31, 2019 2:00 – 3:00 PM EDT
If you have any questions about these events, send an email to [email protected].
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Reminders
• For any questions about this event, contact [email protected].
• Send any technical/programmatic questions [email protected].
• To request a CJR Connect account, go to:https://app.innovation.cms.gov/CJRConnect/CommunityLoginand click “New User? Click Here.”
• Please take a few minutes to respond to the Post - Event Survey!