MAINTAINING A QAPI PROGRAM THROUGH OTTR 7 UTILIZATION

MAINTAINING A QAPI PROGRAM THROUGH OTTR 7 UTILIZATION BY: ROBYN DYE RN, MSN, MBA, CCTC

OBJECTIVES • LEARN NEBRASKA IS A FUN STATE!! • UNDERSTAND HOW OTTR CAN BE USED TO FACILITATE A QUALITY PROGRAM • UNDERSTAND HOW OTTR CAN BE USED TO FOR ORGANIZATION AND COMMUNICATION • COMPREHEND OTTR BEST PRACTICES TO ENSURE DATA IS ACCURATE AND USEABLE • UPGRADE TO OTTR 7 EXPERIENCE

WAKE UP THERE’S LOTS OF THINGS TO DO IN NEBRASKA!!

MY EXPERIENCE WITH OTTR • FLORIDA HOSPITAL LIVER PROGRAM--- CERNER • TEXAS HEALTH HARRIS METHODIST HOSPITAL KIDNEY PROGRAM--- EPIC

OTTR AND QUALITY

WHAT IS QUALITY ASSESSMENT • PROCESS FOR ENSURING COMPLIANCE WITH SPECIFICATIONS, REQUIREMENTS, OR STANDARDS AND IDENTIFYING INDICATORS FOR PERFORMANCE MONITORING AND COMPLIANCE WITH STANDARDS • DETERMINE STANDARDS OF CARE/BENCHMARKS FOR THE POPULATION • DETERMINE HOW TO MEASURE THAT STANDARD • ENSURE YOUR PROGRAM IS MEETING THE STANDARD, OR UNDERSTANDS WHAT NEEDS TO BE DONE TO MEET THE STANDARD

WHY DO WE DO IT? • CMS MANDATES THAT TRANSPLANT PROGRAMS HAVE A COMPREHENSIVE QUALITY ASSESSMENT PROGRAM THAT AT A MINIMUM: • HAS OBJECTIVE MEASURES FOR TRANSPLANT PROCESSES/ACTIVITIES AND OUTCOMES FOR EACH PHASE OF TRANSPLANTATION FOR RECIPIENTS AND DONORS • PHASES INCLUDE PRE-TRANSPLANT, POST TRANSPLANT • THEREFORE…. EVERY TRANSPLANT PROGRAM SHOULD BE TRACKING AT LEAST 12 OBJECTIVE MEASURES!! • IT LEADS TO BETTER PATIENT CARE AND BETTER OUTCOMES

DEFINITIONS • TRANSPLANT ACTIVITY/PROCESS • A SERIES OF ACTIONS OR FUNCTIONS DURING THE DELIVERY OF PATIENT CARE WITHIN THE PROGRAM’S SYSTEM THAT RESULTS IN AN ORGAN TRANSPLANT • PATIENT OUTCOME • A MEASUREMENT OR EVENT THAT IS THE RESULT OF THE TRANSPLANT PROCESS AND DIRECTLY AFFECTS THE LENGTH OR QUALITY OF A PERSON’S LIFE. • POTENTIALLY MODIFIABLE BY A DEFINED INTERVENTION

EXAMPLES OF QUALITY MEASURES FOR TRANSPLANT PROGRAMS

CHRONOLOGICAL SUMMARY PRE TRANSPLANT (ACTIVITY/PROCESS) Chronological Summary Referral Total Current Act. Referrals Ended Referrals (Other than starting Eval) Current Act. Evaluations Ended Evaluations (other than listing) Current Listed Ended Listing -reasons other than TX Transplanted Program Target 30 Monthly <20 at month end <5 each month <95 at month end <10 each month Evaluation Started Ended Charts Closed-Not Listed (Ref/Eval) Program Target # Informational 90% of referral # Informational 100% of started 90 days or less # Informational % of Total 91 -180 days # Informational % of Total Over 181 days Listed Recipients # Chronological # Informational % of Total Program Target 10 per month 100 by end of year 2 <3 each month 3 per month Referral to listing days (Avg) <180 Referral to listing days (Avg) (Hold Removed) <90

PHASE REPORT • SHOWS ALL PATIENTS THAT HAVE BEEN REFERRED SINCE THE REOPENING OF OUR PROGRAM • USEFUL IN DETERMINING WHAT HAS HAPPENED AND WHAT IS CURRENTLY HAPPENING WITH ALL OF OUR PATIENTS • USEFUL TO DETERMINE TIME IN EACH PHASE

DRILL DOWN PRE TRANSPLANT (ACTIVITY/PROCESS) Current Location of Active (Ref/Eval) Patients Wait Time Avg App Received to Entered as Referral 0 Pts <2 days Referral to Phone Intake Request <5 Pts < 2 days Phone Intake Request to Evaluation Start <10 Pts < 7 days Start of Eval to Phase 1 Comp <20 Pts < 30 days Phase 1 Comp. -Phase 2 Comp <25 Pts <30 days Phase 2 Comp. - TAC Presentation <30 Pts <30 days TAC Waiting for additional Testing <25 Pts < 60 days

WAITING TIME LIST • THIS LIST IS USED TO DRILL DOWN AND VIEW THE TIME BETWEEN DIFFERENT STEPS IN THE EVALUATION PROCESS • HELPS US SEE WHERE WE NEED TO FOCUS ON IMPROVING OUR PROCESS

ANNUAL APPOINTMENTS Annual Evals (Health Maintenance) Completed (total) # Informational Within 1 Month of Due Date # (%) # Informational Within 3 months of Due Date # (%) # Informational

LISTED PATIENTS WITH ANNUAL EVALUATIONS • ALL LISTED PATIENT AND INFO ABOUT THEIR ANNUAL EVALUATIONS SCHEDULE • RUNS OFF OF A SPECIFIC ENCOUNTER

INPATIENT AND POST TRANSPLANT PROCESS/ACTIVITY AND OUTCOME Transplanted Program Target Transplant Total # >40 Per year Deceased Donors 30 per year Living Donor Surgeries Deceased Donors Warm Ischemic Time Avg Minutes Deceased Donors Cold Ischemic Time Avg Minutes 10 per year <90 Minutes <7 days Informational DCD Informational Donor KDPI >85% Informational Donor KDPI <85% Informational Kidney Received En. Block Informational Kidney Received on Pump Informational CDC High Risk Informational Hep B Core Pos Informational <5 days < 5 % of Transplants 0 30 Days Post TX 2 6 Months Post TX 2 1 Year Post TX A, non A 1 B <5 % of Transplants 0 Foley Days in Place (AVG) # of PTS with foley left in >5 days AVG Creatinine Level Program Target <1440 Minutes (24 hours) Length Hosp Stay (RECIP) (INI) (AVG Days) # patients that stayed >7 days (INI) Deceased Donor Characteristics 1. 5

CHRONOLOGICAL TRANSPLANT WITH DONOR DATA • POTENTIAL TO CORRELATE WITH OUTCOMES IN THE FUTURE

COMPLICATIONS AND OUTCOMES Recipient Complications Short Term < 6 Months Lymphocele # Bleeding # Surgical Site Infection # Delayed Graft Function # Deceased Donor # Living Donor # Readmissions # Program Target Monitor Trend <20% of total tx Monitor Trend < 1% of total tx Monitor Trend <7% of total tx Monitor Trend <20% of total tx Monitor Trend % of DGF total Monitor Trend <20 % of TX Monitor Trend <20 % of total tx Avg Length of Stay <4 days <9% of total tx % of reop <10% of TX # taking blood thiner prior to tx (Informational) Within 48 HRS of INI DC <10 % of TX 49 HRS- 7 Days of INI DC <10 % of TX 7. 5 Days- 30 Days of INI DC Recipient Reoperation Within 48 Hours Post TX Within 30 days Post TX Blood Transfu. within 48 hrs of TX #

COMPLICATION LIST • USED TO TRACK DIFFERENT TYPES OF COMPLICATIONS AND REPORT FOR QUALITY PURPOSES

OTTR AND ORGANIZATION/COMMUNICAT ION

ORGANIZATION • FIRST OUTLINE YOUR PROCESS AND THEN LOOK FOR WAYS TO AUTOMATE/ORGANIZE • LINKING IS KEY!! • OUR PROCESS • REFERRAL IS ENTERED (INSURANCE IS ENTERED AS AWAITING REVIEW), PLAN WITH ALL ACTIONS NEEDED TO TAKE PLACE DURING THE REFERRAL IS ATTACHED TO THE REFERRAL • ONCE INSURANCE IS MARKED AS ACCEPTED AND REFERRAL IS ASSOCIATED WITH THE INSURANCE, PHONE INTAKE ACTION APPEARS ON THE PHONE INTAKE QUE • ONCE PHONE INTAKE ACTION IS MARKED DONE, ORIENTATION ACTION APPEARS ON SCHEDULING LIST • AFTER CLASS IS COMPLETED, TX COORDINATOR ENDS REFERRAL AND ADDS EVAL MAKING SURE TO LINK REFERRAL TO THE EVALUATION!!

ORGANIZATION • ONCE EVAL IS ADDED AND ORIENTATION ACTION HAS BEEN MARKED DONE, SCHEDULE PHASE 1 ACTION APPEARS • ONCE PHASE 1 ACTION IS MARKED DONE, SCHEDULE PHASE 2 ACTION APPEARS • ONCE PHASE 2 ACTION IS COMPLETED PATIENT REMAINS ON COORDINATOR QUE UNTIL PRESENTED AT ACCEPTANCE COMMITTEE • ONCE PATIENT IS LISTED AND LISTING IS LINKED WITH EVALUATION COORDINATORS ADD AN ACTION FOR WHEN THE ANNUAL EVALUATION SHOULD BE SCHEDULED, THIS ACTION APPEARS ON SCHEDULING LIST ONE MONTH BEFORE IT IS DUE TO QUE THE COORDINATORS TO PUT IN ORDERS AND THE SCHEDULER TO SCHEDULE APPOINTMENT/SEND REFERRAL • ANNUAL APPOINTMENT PROCESS CONTINUES UNTIL PATIENT IS

PRE TRANSPLANT SCHEDULING LIST • UTILIZED TO SEE HOW MANY PENDING APPOINTMENTS ARE OUTSTANDING FOR THE CLINIC

TAC REPORT • USED TO STREAMLINE PRESENTATION FOR TRANSPLANT ACCEPTANCE COMMITTEE

SELECTION COMMITTEE LIST • USED TO SUMMARIZE OUTCOME OF SELECTION COMMITTEE MEETING

OTTR 7 UPGRADE • TIME LINE– ENTERED REQUEST IN THR REQUEST SYSTEM SEPTEMBER 2015 • OTTR 7 WAS IN TEST MARCH 2016 • OTTR 7 PRODUCTION APRIL 2016 • SUGGESTIONS • TEST ALL PROCESSES, LISTS, LINKING, AND REPORTS • MAKE SURE TO INCLUDE YOUR INTERFACE TEAM IN TESTING • COPY YOUR TEST ENVIRONMENT FREQUENTLY AS NEW UPDATES ARE COMING ALONG QUICKLY • FOLLOW INTERNAL PROCESS FOR ADDITIONAL UPDATES

QUESTIONS • ? ? ?

CONCLUSION • I HOPE YOU ENJOYED THIS PRESENTATION AND NOW YOU CAN TELL YOUR FRIENDS BACK HOME THAT YOU LEARNED A LOT AND YOU GOT TO MEET MISS NEBRASKA

REFERENCES • HTTPS: //WWW. CMS. GOV/OUTREACH-ANDEDUCATION/OUTREACH/OPENDOORFORUMS/DOWNLOADS/QAPIRESOURCEGUI DE 090810. PDF