Measurement to generate success
Editor's Note: Abramson Center employees will be presenting on their use of technology to measure resident activity preference Thursday during the McKnight's Online Expo.
In most instances, measurement means evaluating the success of a care plan after its completion. However, only focusing on the “after” is problematic, as measurement is most successful as an evolving process — one that starts “before,” continues “during” and ends upon “completion.” This comprehensive approach allows findings to be interwoven into everyday care, providing a more personalized care plan and ultimately, better outcomes.
The Measurement Makeup
To ensure maximum efficiency, the “triple aim” measurement approach will deliver the highest quality of care by improving the patient experience with care delivery, the quality of care and reducing the per capita cost of healthcare.
Here are five strategic assessments that together create a comprehensive measurement plan:
- Patient Activation Measurement (PAM)- PAM is an important method to determine the patient's level of engagement in his or her own healthcare. How well does the patient control his or her diet? How aware is the patient in recognizing early signs of illness? Answering these simple questions will allow staff to provide care where needed most in order to be successful throughout the patient lifecycle.
o Why it works: This knowledge helps providers develop an individualized plan of care that appropriately assigns resources to growing the patient's capacity toward better self-care, putting into place the proper supports or a combination of both in order to assure a successful transition.
- Depression Assessment - Providers should look to any positive depression screen findings (even mild levels; Patient Health Questionnaire (PHQ-9) scores of >5) as an important opportunity to raise awareness (e.g., through the use of an educational brochure and discussion) and develop a plan designed to address underlying issues that contribute toward the depressive symptoms. Typically, these results go hand-in-hand with activation results from PAM.
o Why it works: Various studies suggest that acute care patients, even with mild level of depressive symptoms, are at significantly higher risk of re-utilization of acute care services (Mitchell et. al 2010).
- Better Outcomes by Optimizing Safe Transitions (BOOST)- The BOOST tool was developed to identify the salient areas of a patient's history or condition that place him or her at risk for negative care transition. It helps to indicate the level and specific types of follow-up needed and to properly allocate resources. Again, these risk areas, in conjunction with the patient's activation and engagement levels uncovered with PAM, help put appropriate interventions in place.
o Why it works: The BOOST risk assessment tool uses an empirically based algorithm to help identify those risk factors which are proven to be related to poorer transition outcomes. By weaving in an aftercare plan and follow-up that address these risk factors, efforts are placed in areas that will likely have a higher probability of reducing risk of premature rehospitalization.
- Treatment Assessments- Beyond assessing what works for each individual client, providers are advised to take a holistic view of the various existing medical conditions and successful treatments to develop consistent protocols in treating common conditions. For example, the Cardiac Protocol was developed at the Abramson Center for Jewish Life's rehabilitation center, Birnhak Transitional Care, after two years of patient learnings and is now ordered within the initial hours of patient admission. The key elements of the protocol include: daily weight and lung assessments, three times-a-day vital signs and pulse oxygenation checks, and a two-gram sodium diet.
o Why it works: The earliest detection of a patient decline affords the clinical staff with precious opportunities to adjust treatments in order to get a patient back on his or her recovery track. Protocols around specific risk areas provide a defined set of observations for staff to focus on.
- Follow-Up Assessments- During follow-up, providers should take advantage of the depth of measurement conducted throughout the patient's history. This information is critical to administering meaningful follow-up assessments in the proper context. For example, if it became known during an assessment of ADLs or IADLs, that a son or daughter lived with the patient and was the primary caregiver, follow up would also include assessing whether that family member is still active in the patient's life; if not, this is an excellent opportunity to intervene and put an alternative support in place. Again, this helps to properly allocate resources, but most importantly, helps to provide a better quality of care and life.
o Why it works: Even the best plans can fail because circumstances change from what was initially presented. Having a clear, specific follow-up plan assists providers in making minor adjustments before they become bigger problems.
While the above five key assessments make for a comprehensive evaluation program, the ability to assess and measure its success is truly an ever-evolving process. In the end, it's a strict adherence to a system of individualized patient care, continual learning and evaluation, and improvement based on individual circumstances that will lead to the best outcomes and highest quality of care.
Valerie Palmieri is the Chief Operating Officer at Abramson Center for Jewish Life.
Source: Mitchell SE1, Paasche-Orlow MK, Forsythe SR, Chetty VK, O'Donnell JK, Greenwald JL, Culpepper L, Jack BW. (2010) Post-discharge hospital utilization among adult medical inpatients with depressive symptoms. J Hosp Med. 2010 Sep;5(7):378-84. doi: 10.1002/jhm.673.