Ready, Set, Go! Getting (Re)Started with TAKEheart

Combined Module 1 & 2

Kim Newlin, RN, CNS, ANP-C Hicham Skali, MD, MSc

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Welcome Partner Hospitals!

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Today’s Event

Background TAKEheart launched in January 2020. Module 1 was delivered in January 2020 followed by Module 2 in February 2020. Due

to the COVID-19 Public Health Emergency, TAKEheart paused training activities in March 2020.

Today TAKEheart resumes with a condensed version of Modules 1 and 2. Participating hospitals continue process of learning and sharing with each other.

TAKEheart website https://takeheart.ahrq.gov/

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PARTICIPANTSMODULE 1 RECAP

Cardiac Rehabilitation Change Package (CRCP): Roadmap for Training

The training, educational resources and technical assistance offered by TAKEheart are designed to support the implementation of evidence-based strategies contained in the Million Hearts®/AACVPR Cardiac Rehabilitation Change Package (CRCP).

Access the Change Package at: TAKEheart Website Resource Center

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PARTICIPANTSMODULE 1 RECAP

CRCP Overview

Produced by Million Hearts in collaboration with American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) board members, headquarters staff

Contributions from over 20 hospitals/health systems 100+ tools and resources: AACVPR strategies Case studies Program specific tools Organization specific tools: CDC, AHA, ACC

Expertise, tools, and resources from: 18 states 22 institutions 36 CR professionals and researchers

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Instructional Format

EVERYONE LEARNS

• Training Curriculum• 10 modules to guide the

implementation of automaticreferral and effective carecoordination

• Implementation Guides• Supplemental documents for

each module, which outline thecontent, and provide specificactions, steps and resourceshospitals can use to assist withthe project.

EVERYONE SHARESEVERYONE SUPPORTS

• Partner Hospital Peer ActionGroups (PH PAGs)• Small groups of hospitals

meet monthly with a coach• Discuss the most recent

module content• Share ideas and offer

support to other hospitalsin the group.

Summary of Training Curriculum Foundational Activities

Module 1: Welcome to the TAKEheart Initiative and the Benefits of Increasing Cardiac Rehabilitation Participation Module 2: Systems Change: Creating a Team and Plan to Support Systems Change Module 3: Systems Change: Understanding Your Workflow Processes to Prepare for Systems Change Module 4: Systems Change: Preparing and Understanding Your Data to Foster Systems Change Module 10: Options to Expand System Capacity and Patient-Centeredness

Automatic Referral Implementation and Refinement Module 5: Building and Implementing a Successful Automatic Referral System Module 7: Troubleshooting Your Automatic Referral System

Effective Care Coordination Implementation & Refinement Module 6: Laying the Groundwork for Effective Care Coordination Module 8: Implementing Care Coordination Module 9: Engaging and Empowering Patients and Families for Success in Cardiac Rehabilitation

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American Hospital Association (AHA)/Health Research and Education Trust (HRET): TAKEheart AHRQ’s Initiative to Increase Use of Cardiac Rehabilitation Ready, Set Go! Getting Started with TAKEheart Module 1 & 2 May 27, 2021

The planners and faculty of TAKEheart Initiative Module 1 & 2 indicated no relevant financial relationships to disclose in regard to the content of their presentations with the exception of:

Hicham Skali,MD, MSc, faculty for this educational event, received a research grant from ABT Associates. This presentation has been reviewed and is found to contain no bias. There are no other relevant financial relationships to disclose regarding the content of this presentation.

Kim Newlin, RN, CNS, ANP-C, faculty for this educational event, received consulting fees from Kinetix. She also received consulting fees and speaker fees from Boehringer-Ingelheim. This presentation has been reviewed and is found to contain no bias. There are no other relevant financial relationships to disclose regarding the content of this presentation.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and American Hospital Association (AHA) / Agency for Healthcare Research and Quality (AHRQ). ABQAURP is accredited by the ACCME to provide continuing medical education for physicians.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 1.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

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PARTICIPANTSLearning Goals

Learning Goals Upon completion of this module, you should be able to:

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Understand TAKEheart and the opportunity it provides to close the gap between evidence and practice to increase patient participation in cardiac rehabilitation.

Make the case to your leadership for taking active steps to increase CR participation by implementing automatic referral and care coordination support and begin to build buy-in among other members of your implementation team.

Understand the role of CR champion in the quality improvement project.

Identify key members of a multidisciplinary CR QI team, e.g., representatives from key departments and patient advisors.

Create an aim statement as part of an overall action plan for implementation of automatic referral with effective care coordination.

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PARTICIPANTSINTRODUCTIONS

Today’s Presenters

Hicham Skali, MD, MSc TAKEheart Principal I nvestigator, Associate

Director of the Cardiac Rehabilitation Program at Brigham and Women’s Hospital,

Division of Cardiovascular Medicine

Kim Newlin, RN, CNS, ANP-C

Director of Nursing Clinical Operations at Sutter Roseville Medical Center

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PARTICIPANTSData Tracking for Quality ImprovementFOR HOSPITALS/HEALTH SYSTEMS: Data for Quality Improvement, Reporting

Ready, Set, Go!

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Audience Question 1

Question 1: What best describes your feelings about the TAKEheart project?

Please select your answer here

Remember to click SUBMIT when complete

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Audience Question 2

Question 2: As you resume TAKEheart, what do you anticipate being your biggest challenge?

Please select your answer here

Remember to click SUBMIT when complete

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What is TAKEheart?

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PARTICIPANTSEVIDENCE-BASED APPROACH

The Opportunity: How to Close the Gap

EVIDENCE-BASED APPROACH

• Automatic referral: EMR based referralbuilt into order set, default, opt-outmodel where ALL patients withqualifying diagnoses are referred andrelevant providers are notified

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PARTICIPANTSEVIDENCE-BASED APPROACH

The Opportunity: How to Close the Gap

EVIDENCE-BASED APPROACH

• Care coordination support: Can be dedicated staff or someone in- house taking on role with appropriate training on program. Meets with patient to introduce CR and coordinate referral.

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PARTICIPANTS

The Opportunity: How to Close the Gap

EVIDENCE-BASED APPROACH

• In a 2011 study, implementing automatic referralto CR increased participation to 70% compared tocontrol (32%). Automatic referral with carecoordination support increased participation to86%.

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PARTICIPANTSFOR SYSTEMS AND SOCIETY

FOR SYSTEMS& SOCIETY

Making the Case for Cardiac Rehabilitation

FOR HOSPITALS/HEALTH SYSTEMS • National guidelines indicate that CR is a class 1a

recommendation (AHA/ACC) for MI & CABG

• CR promotes better quality, care management and limits avoidable adverse events

− CR has reduced emergency department, avoidable hospitalizations and long-term care utilization

• CR is a relatively low-cost intervention compared to inpatient treatments for acute cardiac conditions, and provides a high return on investment given the impact of its benefits

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PARTICIPANTSFOR SYSTEMS AND SOCIETY

FOR SYSTEMS& SOCIETY

FOR HOSPITALS/HEALTH SYSTEMS INFOGRAPHIC

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Importance of CR

PATIENT STORY

Steven Merchant

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PARTICIPANTSQUALITIES TO

CONSIDER

Cardiac Rehabilitation Champion

SKILLS Credible and influential with peers

Passion and interest in improving CR

Understanding of CR programs, structure and regulations

Action oriented

Experience with change management and improvement projects

Communication skills

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PARTICIPANTS

Cardiac Rehabilitation Champion (cont.)

ROLE Team Leader

Engages and collaborates with hospital leadership to obtain support for automatic referral with care coordination

Understands staff and patient needs, as well as management

Manages conflicting interests and scarce resources to get things done

Helps to build a culture to support change

Assists team in developing its Aim Statement and Action Plan

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PARTICIPANTS

Forming Your Multidisciplinary CR Implementation Team

CHOOSING TEAM MEMBERS

Decide who will be involved with implementing automatic referral and establishing effective care coordination.

Bring together individuals who represent all parts of the CR referral, enrollment and participation process

Plan for coordination across inpatient and outpatient settings by involving staff members from both

Include billing and insurance personnel

Include staff or patients (advisors) who can address the needs and concerns of patients

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PARTICIPANTS

Potential Multidisciplinary CR Team Members

CR Champion: leads the team and advocates for the initiative

Cardiac care clinicians: cardiologists, cardiac surgeons, physician assistants, or nurse practitioners provide input on treatment and referral

Cardiac Rehabilitation clinicians: nurses, physical therapists, exercise physiologists, physicians provide valuable perspectives on enrollment and participation

Cardiac care manager: provides important information about current workflows and potential areas for improvement

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PARTICIPANTS

Potential Multidisciplinary CR Team Members (cont.)

Information Technology (IT) staff: possess the skills necessary to enact the required changes for automatic referral and data collection. May include IT vendor representatives.

Quality improvement leaders (QI): provide insight into best practices for implementing and measuring quality improvement.

Patients: provide the end user perspective.

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PARTICIPANTS

Set the Stage for Change: Model for Improvement

MODEL FOR IMPROVEMENT

What are we trying to

accomplish?

How will we know that a change is an

improvement?

What change can we make

that will result in

improvement?

TAKEheart change/improvement = Automatic referral with effective care coordination

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Action Plan Components

PARTICIPANTS• Develop an Aim Statement Element

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Element 2

• Determine how to assess or measure yourprogress

Element 3

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• Identify the tasks required to achieve the aim, who is responsible for each task and the timeframe for completing each task

PARTICIPANTS

Element 1: The Aim Statement

WHAT IS IT? Why create an aim statement?

Acts as your beacon to guide and focus your team’s efforts

An aim statement answers: What are we trying to accomplish?

It is an explicit statement, crafted by the team, of the desired outcome of your improvement project

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PARTICIPANTS

TAKEheart Aim Statement

AIM STATEMENT Q: What do you hope to accomplish? A: Increase cardiac rehabilitation referrals, enrollment, and participation

Q: For whom? A: Patients with eligible diagnoses, e.g., MI, CABG, PCI

Q: Why is it important? A: Improves health, saves lives and reduces hospital readmissions

Q: What change will you implement to achieve your aim? A: Automatic referral with effective care coordination

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PARTICIPANTSGOALS

S.M.A.R.T. Goals

Specific: Description of a specific outcome or process

Measurable: How is it going to be measured, e.g., rate, frequency?

Achievable: Plan to stretch but make sure it is achievable

Relevant: Need to link directly to the Aim statement

Time bound: Need clear start and finish dates

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PARTICIPANTSEXAMPLE

A TAKEheart Aim Statement Example

We aim to increase the number of patients with MI, PCI and CABG who are referred, enrolled and participate in cardiac rehabilitation by 30%. This is important because we want to improve patient care and outcomes and reduce hospital readmissions. We will accomplish this aim by implementing automatic referral with care coordination by March 31,2022. We intend to see a 30% increase in current participation rates by December 31, 2022.

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PARTICIPANTSData Tracking for Quality Improvement

Element 2: Measure Progress

Tracking data as part of TAKEheart supports quality improvement

Increasingly, CR metrics (referral, enrollment, adherence rates; time to refer, etc.) are being incorporated into quality performance programs and can drive reimbursement

Reporting performance and quality metrics promotes health systems’ ability to work in a value-based, risk-taking environment, increasingly prevalent among payers.

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Assess Your Progress

MEASUREMENT

INCLUDE BOTH SHORT TERM AND LONG-TERM

ASSESSMENTS.

DEVELOP SPECIFIC OUTCOME AND

PROCESS MEASURES.

SET SPECIFIC GOALS THAT ARE NUMERIC AND MEASURABLE.

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PARTICIPANTS

Examples

S.M.A.R.T. GOALS

The percentage of eligible patients referred to cardiac rehabilitation will increase by 10% from Q1 to Q3.

The percentage of referred patients who enroll in a CR program will increase by 5% from Q1 to Q2.

The percentage of enrolled patients who complete a CR program will increase by 15% from Q2 to Q4.

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PARTICIPANTSIDENTIFY ACTION PLAN

COMPONENTS

Element 3: Tasks, Responsibilities & Timeframes

What tasks does your hospital need to undertake to implement automatic referral?

What tasks does your hospital need to undertake to establish effective care coordination?

Who will lead each task?

When will each task be completed?

Consider resource needs and priorities

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PARTICIPANTS

Utilize an Action Plan Template

TEMPLATE

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PARTICIPANTS

Tasks Need S.M.A.R.T. Goals Too

TASK: DEVELOP AUTOMATIC REFERRAL SPECS

Beginning 6/4/2021, the CR QI team will meet with IT representatives each Tuesday and Thursday at noon for a half hour to define the changes necessary for automatic referral and will complete the task by 7/28/2021.

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PARTICIPANTSCR WORKFLOW PROCESSES

Q & A

Our panelists are ready for your questions

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PARTICIPANTS

What’s Next?

PH PAGS

Continue working with your CR Team to write your aim statement and identify initial tasks for the action plan

Discuss your progress and challenges with other hospitals in the group

Exchange ideas and seek feedback from other hospitals on your aim statement in your PH PAG

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PARTICIPANTSCR WORKFLOW PROCESSES

Module 3

Understanding your Workflow Processes to Prepare for Systems Change

June 24, 2021, 3pm – 4pm ET

Module 3 Registration Link: https://abtassociates.webex.com/abtassociates/onstage/g.php?MTID=edf1661d4baa f841333b9583f827f2bfd

“Automating bad processes does not improve anything…our experience is that it is best to fix the process, then automate the fixed process.” Dr. John Halamka, CIO BIDMC, Boston, MA

Help us help you! Please answer the survey questions as you leave the event today

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