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AMDA's 2015 Annual Conference


A40 - Person-Centered and Data-Driven Care: How Innovation Among Centers for Medicare & Medicaid Services Innovation Center (CMMI) Demonstration Projects is Personalizing Care Across Several States


Mar 19, 2015 1:30pm ‐ Mar 19, 2015 5:00pm


Credits: None available.

Standard: $24.00

Description

Accreditation Statement: AMDA – The Society for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement: AMDA – The Society for Post-Acute and Long-Term Care Medicine designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ABPLM Designation Statement: This Internet Enduring Material has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for a total of 3.5 management hours toward certification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. The CMD program is administered by the ABPLM.  Each physician should claim only those hours of credit actually spent on the activity.

Session Description:
In 2012, the Centers for Medicare & Medicaid Services Innovation Center (CMMI), in partnership with the Medicare/Medicaid Coordination Office, funded a project in seven sites to improve the quality of care for residents in nursing homes by reducing avoidable hospitalizations. The organizations involved partner with nursing homes to implement evidenced-based interventions aimed at improving care and lowering costs. Most interventions entail promoting person-centeredness. In this session, four of the seven project medical directors will present examples from their projects that demonstrate how they are using person-centered care concepts and data to drive change in their facilities. Barriers and facilitators to change will be discussed. Presenters will describe ways to identify residents at high risk for rehospitalization, ways to improve care coordination/care transitions, ways to improve advance care planning, and ways to engage physicians in quality improvement efforts.

Learning Objective(s):

  • Describe innovative person-centered, data-driven care practices implemented by demonstration projects in 4 states
  • Recognize facilitators and barriers to successful implementation of innovative person-centered ideas
  • Discuss tactics for physician and interdisciplinary staff engagement in quality improvement efforts
  • Identify ways to use data in their own facility to promote person-centered strategies

Speaker(s):
Clare I. Hays, MD, CMD
Charles A. Crecelius, MD, PhD, CMD
Arif Nazir, MD, CMD
Steven L. Phillips, MD

Disclosure(s):
None

Reference(s):
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff 2008; 27: 759 e769. Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. Available at: http://innovation.cms.gov/initiatives/rahnfr/ Accessed July 10, 2014 Ouslander, JG,  Bonner, A, Herndon, L, Shutes, J. The Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long Term Care. JAMDA 15 (2014) 162-170. Ouslander JG, Maslow K. Geriatrics and the triple aim: Defining preventable hospitalizations in the long term care population. J Am Geriatr Soc 2012; 60: 2313 e2318. Ouslander JG, Berenson RA. Reducing unnecessary hospitalizations of nursing home residents. N Engl J Med 2011; 365: 1165 e1167. Ouslander JG, Lamb G, Perloe M, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc 2010; 58: 627 e635. Ouslander JG, Lamb G, Tappen R, et al. Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. J Am Geriatr Soc 2011; 59: 745-753 Molloy DW, Guyatt GH, Russo R, et al. Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA 2000; 283: 1437 e1444. QAPI. Available at: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/NHQAPI.html. Accessed July 10, 2014. Walsh EG, Wiener JM, Haber S, Bragg A, Freiman M, Ouslander JG. Potentially Avoidable Hospitalizations of Dually Eligible Medicare and Medicaid Beneficiaries from Nursing Facility and Home- and Community-Based Services Waiver Programs. J Am Geriatr Soc 2012: 60: 821–829. Walsh EG, Wiener JM, Haber S, et al. Potentially avoidable hospitalizations of dually eligible Medicare and Medicaid beneficiaries from nursing facility and home- and community-based services waiver programs. J Am Geriatr Soc 2012; 60: 821 e829. Walsh EG, Freiman M, Haber S, Bragg A, Ouslander J, Wiener JM. Cost Drivers for Dually Eligible Beneficiaries: Potentially Avoidable Hospitalizations from Nursing Facility, Skilled Nursing Facility, and Home and Community- Based Services Waiver Programs. Final Task 2 Report for CMS. RTI Project Number 0209853.022. April 2010.

Speaker(s):

Credits

Credits: None available.

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