1. society
2. welfare
3. healthcare
4. hospital

2015 GOAL IN FEBRUARY
February was a tough month for the MOQI nursing homes. The total rate for February reached the
highest rate since the start of the project. Recall our goal for 2015 is 1.3. The yellow line graph attached
to the newsletter illustrates the overall rate for February of 2.92.
Homes with the highest rates in February were:
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Delmar Gardens on the Green with 5.81
Festus Manor with 4.80
Delmar Gardens North with 3.83
Delmar Gardens of Chesterfield with 3.09
Delmar Gardens West with 2.95
Scenic Nursing and Rehab with 2.82
Cedarcrest Manor with 2.61
There were two homes near 1.5, the 2014 goal. These were Alexian Brothers Lansdowne with 1.52 and
Delmar Gardens South with 1.55. Good job! All homes are now focused on better performance in March.
DATA REVIEW/FEEDBACK WEBINAR ON APRIL 1ST AT 1:30PM
Mark your calendars!! A feedback webinar is coming to review the hospitalization graphs, discuss how
some homes are reaching goals (some months), and to share effective strategies. We will also be sharing
key revised feedback graphs to try and make things simpler when receiving the monthly reports. You
must register for the webinar in order to attend!!
For example, attached to this update is a new line graph, the yellow line graph referred to above, which
you will receive each month. One shows the overall project, plus each home will have their own graph
that shows your rate for each month since the project began providing feedback reports in September
2013. (The home-specific graph will be sent out separately from this update.) You will receive an updated
graph each month, so print out your home’s and post it where you and your staff can see your progress!!
Then celebrate as you improve and reach the goal of 1.3 for 2015 and 1.1 or lower for 2016!!!
Also, attached to this newsletter are the two key graphs for the total project, prepared and sent to you by
Janice each month: 1) the blue bar graph “Total Hospitalizations by Home” for February 2015, and 2) the
yellow bar graph “Total Hospital Transfer Rates by Home” for February 2015. The blue bar graph (1) has
the actual numbers of hospitalizations each month that must be achieved to reach the hospitalization rate
goals for each home. Remember, if you have questions about your specific home, just send an e-mail to
Janice Dixon-Hall, Database Coordinator, and she will be glad to talk with you or meet with you to explain
your home’s calculation.
The care transitions team is gearing up for our second annual National Healthcare Decisions Day events
slated for April 16th. Last year each home held advance directive clinics in which volunteer attorneys,
notary publics, and expert volunteers were available to help people with counseling on advance directives
PAGE1
NATIONAL HEALTHCARE DECISIONS DAY - APRIL 16TH, 2015
and with enactment of their advance directive documents. The most successful of these happenings had
events and celebrations connected to the clinics and had people sign up to meet with the volunteer
attorneys in advance. We are anticipating 100% participation this year and homes are planning programs
and events unique to their setting. Ideas and resources can be found at the National Healthcare Decisions
Day website at http://www.nhdd.org/public-resources/. Visit this website to access some wonderful
resources!
Delmar Gardens’ homes are planning many interesting educational events that day in their homes along
with offering the clinics. These events are sure to be a success! Thank you Delmar Gardens for your
enthusiasm and willingness to provide some great opportunities for your residents, families, and staff!
PRESENTATION OF ILLNESS IN OLDER ADULTS
The following information is excerpted from an article in the Association of periOperative Registered
Nurses (AORN) journal, 2006, V83, #2.
“Early recognition of indicators of... health problems, including change in mental status, falls, dehydration,
decrease in appetite, pain, loss of function, dizziness and incontinence, can mean an opportunity to
initiate treatment while recovery is still possible.” To accomplish the goal of reduced hospital transfers
from your home, early illness recognition skills by your nursing staff are needed. As people age, there are
multiple changes that take place, such as cardiac muscles thicken, brain and spinal cord degenerates,
kidneys shrink and bladder muscles weaken. Adding to the physical changes is the fact that people over
age 65 take more medications than their younger counterparts. Polypharmacy among the elderly can lead
to change of mental status, a symptom that may mistakenly be attributed to old age. These many changes
of aging can mask early signs of illness in your residents. An example is the decreased ability to respond to
pathogens by initiating an inflammatory process (fever). What this delay can mean is by the time a
resident has a fever develop, they have already been ill for a couple of days.
Acute illness among the elderly can be detected earlier by paying attention to the many changes
mentioned above. Functional decline research has shown is the frequently the first sign that a condition
change has occurred in the resident. CNAs, who provide 80-90% of nursing care in a nursing home, are the
staff who first notice these changes. The changes can be documented by the CNA using the INTERACT
Stop and Watch tool and follow-up by the nurse in charge of the resident, can be the first opportunity to
perform a resident assessment that can lead to initiating treatment. When a condition change occurs,
monitoring the resident is not an action that will lead to recovery. Probability says the resident is already
acutely ill and is also dehydrated, if an infectious process is at work. When your APRN is in your home,
they need to be consulted ASAP, so a through clinical assessment can be performed and the attending
physician be contacted using the SBAR tool. Early recognition of condition changes and prompt
assessment of the resident provides the opportunity for them to be treated in the nursing home, an
environment that they are used to. Transfers to hospitals for illnesses that could have been treated at the
nursing home are not in the resident’s best interest. Research shows that residents experience more
functional decline during hospitalizations and experience complications such as delirium, falls and
pressure ulcer development.
MARK YOUR CALENDARS: LEADERSHIP MEETING APRIL 23RD, DELMAR GARDENS CORPORATE
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The MOQI Leadership Group will meet on Thursday, April 23rd, from 10AM to noon, so be sure to plan to
attend! This will be an important meeting with key updates and insights from the MOQI Initiative. Key
points will include guidance from Dr. Chuck Crecelius, project Medical Director. Dr. Marilyn Rantz, Project
Director, will be reviewing updated hospitalization rate graphs with the hospitalization goals with the
group. Thanks to Dr. Marcia Flesner, Project Coordinator, for getting the CEUs processed for the meeting
for the nursing home administrators.
INTERACT PROGRAM UPDATE
Sustainability
During the remainder of the MOQI project, it is important to think about how the basic INTERACT
tools/forms will be sustained in your nursing home at the end of the project. We encourage each of you
to collaborate with your APRN to explore ways to sustain the use of the STOP & WATCH and SBAR forms.
Evidence shows that the use of these two forms improves quality measures and reduces potentially
avoidable hospital transfers. The article on page 2 of this newsletter, “Presentation of Illness in Older
Adults”, reinforces how the use of these forms, in consultation with your APRN, will better manage the
changes in residents’ conditions in the nursing home and prevent potentially avoidable transfers to acute
care facilities! Please contact Maryann Coletti, the INTERACT Coach, at [email protected] if you
have any questions about sustainability of the INTERACT Quality Improvement Program.
CARE TRANSITIONS
Education Initiatives
The care transitions team will be holding an educational seminar on March 27th from 9AM to 11AM at
Delmar Gardens Corporate for social workers, Pathways Hospice staff, and interested APRNs. The seminar
is on the Missouri Bar Advance Directive form which will be used in the clinics that are being set up for
National Health Care Decisions Day. Brigid Fernandez Esq is our featured speaker. Ms. Fernandez has
coordinated volunteer attorneys to participate in the National Health Care Decision Day Clinics for over
seven years. There will be free CEU’s for social workers who attend the event.
Save the date! The Conversation Project is coming to St. Louis on September 29th. The Conversation
Project leadership will be sharing their awesome experiences on how to have meaningful conversations
about end-of-life care. This organization was founded by Ellen Goodman and they have been successful in
helping people and communities organize to have this important discussion. The evening event will be
held at the Ethical Society of St. Louis. For a personal starter kit on How to Start the Conversation go to
this web link: http://theconversationproject.org/wp-content/uploads/2013/01/TCP-StarterKit.pdf. The
Conversation Project works in collaboration with the Institute for Healthcare Improvement.
ADVANCE DIRECTIVES SUBCOMMITTEE
The Advance Directive Subcommittee next meeting is scheduled for March 26th from 3PM to 5PM at Delmar
Gardens Corporate.
Members of the subcommittee are Colleen Galambos, PhD, LCSW; Charles Crecelius, MD, PhD, CMD;
Mike Roth, LNHA; Adrienne Holden, MSW, ACSW; Lori Popejoy, PhD, APRN, GCNS-BC; Annette
Lueckenotte, MSN, RN, FNGNA; Keith Hampton, RN, APRN; Yvonne Schwandt, RN, BSN; Brigid Fernandez,
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Our third webinar of a three-webinar series will be held on May 18th 12:30PM to 1:30PM and will feature
Brigid Fernandez Esq, Elderlaw attorney at Martha C. Brown & Associates in St. Louis. She will be
presenting on “Legal Steps in Advance Care Planning: Planning for Incapacity”. Co-sponsors for this event
are: Voyce, St. Louis University Geriatric Education Center, and Primaris. This series is geared to
professionals and people working in the health care industry. The events are free, but limited to 500
participants and require registration.
LCSW, Elderlaw attorney; Jan Doerr, MA, LBSW, CPG, social worker at Delmar Gardens of O’Fallon; Roger
Schomburg, Chaplain at Alexian Brothers Corporate; and Kayla Steinke, Voyce. Please contact Colleen if
you have any issues or concerns about advance directives or if you are looking for some guidance. The
subcommittee generally meets on the 4th Thursday of the month from 3PM to 5PM.
HIT AND MHC CAREMAIL
Most of the homes have already implemented a process to review the hospital discharge summaries that
are being sent to the shared social services CareMail box. Since the paperwork that accompanies the
resident home from the hospital doesn’t contain the physician’s discharge note or orders, the reports sent
through CareMail are beneficial to a safe Care transition. Please review the following to ensure you are
maximizing the valuable information in these reports:
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Who currently has access to the social services CareMail box?
Are they receiving notifications in their regular work email?
What is your process for handling the messages received? (i.e. prints the report, forwards to
others in need of information for clinical care, etc.)
Who is reviewing the report and comparing to previously received information to identify
potential oversights or errors?
Where is this information archived?
Sue Shumate would be happy to assist with any questions you may have regarding the information being
received from the hospitals or process development. Several situations have arisen in which this
information has proven very useful! As a reminder, Mercy, St. Luke’s, BJC-Missouri Baptist, and SSM are
currently sending discharge CCD (Continuity of Care Document) reports through CareMail. Currently, the
reports being sent from SSM are not able to be accessed in a readable format. They have been very
cooperative in working with our Nursing Home IT partners and MHC to resolve this issue.
Please ensure your designated staff is accessing this mailbox to view hospital discharge summaries and
other communications from BJC, St. Luke’s, Mercy, and other hospitals. Sue is asking that the CareMail
system administrators of these homes contact her if assistance is needed.
Thank you for continuing to identify new uses for CareMail with your communication of PHI and other
sensitive information. This is a wonderful opportunity for improving patient safety and security of PHI
communications for your residents. Keep the updates coming!
HIT SUBCOMMITTEE
Some topic highlights from our last meeting:
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MHC CareView - review of functionality and identification of pilot home for demonstration
CMS presentation - Opportunities and Challenges of HIE between LTPAC and Acute Care homes
SSM - Discussed SSM connect (Direct messaging) and EpicCare Link (View only Access to hospital
records)
Delmar Gardens Matrix - potential of CCD capabilities
, formal process development for CareMail and HIE and new developments in report communication and
information sharing from hospital partners. Save the Date! Next meeting: Thursday, April 9th at 3PM
(Conference Call and in-person attendance option).
PAGE4
Attendees of the committee are selected representatives from the nursing homes, hospital pilot partners,
and MOQI team members. Ongoing topics being addressed by the committee include MO Health
Connection’s (MHC) CareMail and CareView implementation strategies in the homes
CareMail Usage Surveys
The CareMail survey has been closed and the results are being forwarded to an analyst for review. The
results will be shared shortly. Initial review showed insightful responses and thoughtful feedback. Thanks
to all that participated!
CMS Webinar - Opportunities and Challenges of HIE between LTPAC and Acute Care Facilities
Progress is being made on the CMS webinar that will be presented at the CMS ECCP meeting held in
Baltimore. Our team will be presenting at 10:00AM CST on May 1st, 2015. Representatives from CMS
were excited about us offering a webinar at our meeting of all seven ECCP sites within the CMS
project that are located around the country. The following partners have confirmed their
participation:
St. Luke’s - Michelle Miller and Susan Brinker
BJC - Susan Sullivan
Mercy - Annette Richardson Latham
Delmar Gardens - Pam Manion
MHC - Chris Schimpf
The goal of the webinar is to share with other ECCPs the progress made by our hospital partners in
developing and communicating discharge summary information to MOQI homes to improve Care
Transitions and enhance patient safety.
CareMail Reminders
If you are in need of assistance re-setting your password, please contact your system administrator so
they may handle this for you. If a system administrator needs guidance accessing the administrator portal,
they should contact the MHC Helpdesk first at (866) 350-4778.
As we are allotted a set number of mailbox licenses, it’s important to have an accurate accounting of all
active mailboxes. System administrators, do not add a mailbox without approval and please remember to
suspend the mailbox through the administrator’s portal for a staff member that leaves and to
communicate these changes to both Sue at [email protected] and the MHC helpdesk at
[email protected].
UPDATES ON DATA COLLECTION/DATABASE
Just a few quick things we’d like everyone to keep in mind:
1. Please remember that all long-term care residents should be entered into the roster, but only
eligible with: Medicare and/or Medicaid, no Managed Care Plan, and no discharge plan.
2. If a resident is discharged from the home, but returns within 30 days, remember to update the NF
readmission date for beneficiaries section on the roster with the resident’s readmission date.
As always, please contact Jessica Mueller, Janice, or Sue if you have any questions or problems with the
functionality of the database so it may be addressed immediately.
PAGE5
If you have questions about your Monthly Performance Reports on Hospitalizations and Other Key
Outcomes for the Initiative, contact Janice, as she is the person generating these reports each month.
She’ll be glad to make a site visit to your home and explain the reports to your leadership team. She
prepares the reports and sends them to each home’s leadership and APRN the week after the database
has been completed for the prior month.
GOALS FOR 2015
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Focus on staff retention strategies
Work with staff and build care systems for early illness recognition and prevention
o Hydration
o Mobility
o Nutrition
Help residents, families, health care providers, and staff with decisions about advance directives
Reinforce INTERACT and CareMail use
Achieve a hospitalization rate below 1.30
UPCOMING MEETINGS!!
Our next MOQI NF LEADERSHIP GROUP meeting will be on Thursday, April 23rd, 2015 at Delmar Gardens
Corporate (14805 North Outer 40 Road, 3rd floor, Chesterfield, MO 63017), from 10AM to noon! Mark your
calendars and plan to attend!
Our next MOQI STAKEHOLDER ADVISORY BOARD meeting will be Thursday, April 23rd, 2015 from 1PM to 2PM.
Mark your calendars and plan to attend! Delmar Gardens Corporate, 14805 North Outer 40 Road, 3 rd
floor, Chesterfield, MO 63017. We invite you to join this group! We always welcome additional
perspectives and input.
TOPICS FOR UPCOMING MOQI UPDATES; CONTACT INFORMATION
If you have a particular request, please submit to Jess and we will be sure to cover it. If you would like others
to be added to this communication list, please contact Jess at [email protected].
WEBSITE SECTION FOR YOUR USE
There is a special section on the www.nursinghomehelp.org site for us to use for the Initiative. It contains contact
information, material/overviews, copies of all of the updates, etc. Use the link below or type it in and bookmark it:
http://nursinghomehelp.org/moqi.html. If there is something you would like to request be added, please e-mail Jess.
Participating nursing home administrators, please share these MOQI Updates with your director of nursing and other
leadership staff so they are being informed about the project!
PAGE6
Attachments: Hospital transfer rates; Total hospital transfer rates by home; Total hospitalizations by home; Lunch and
Learn webinar flyer
3.0
Feb '15
2.92
2.9
Feb '14
2.82
Oct '13
2.82
2.8
Mar '14
2.83
May '14
2.76
2.7
Oct '14
2.69
Nov '14
2.72
Jul '14
2.61
2.6
Jan '14
2.53
2.5
Dec '13
2.45
Sep '13
2.45
Apr '14
2.42
2.4
Dec '14
2.42
Nov '13
2.34
Jun '14
2.33
2.3
Aug '14
2.22
2.2
Sep '14
2.18
Jan '15
2.15
2.1
2.0
Tx Rate
Sep '13
Oct '13
Nov '13
Dec '13
Jan '14
Feb '14
Mar '14
Apr '14
May '14
Jun '14
Jul '14
Aug '14
Sep '14
Oct '14
Nov '14
Dec '14
Jan '15
Feb '15
2.45
2.82
2.34
2.45
2.53
2.82
2.83
2.42
2.76
2.33
2.61
2.22
2.18
2.69
2.72
2.42
2.15
2.92
Total Hospital Transfer Rates by Home - February 2015
6.50
6.00
5.81
5.50
5.00
4.80
4.50
3.83
4.00
3.50
3.09
3.00
2.95
2.82
2.61
2.50
2.40
2.38
2.19
2.13
2.00
1.50
1.93
1.90
1.90
1.55
1.52
Delmar
Gardens
South
Alexian
Brothers
Lansdowne
Village
1.55
1.52
2015 Goal 1.30
1.00
0.50
0.00
February Hospital Transfer Rates
2013-2014 Data
Delmar
Gardens on
the Green
Festus
Manor
Delmar
Gardens
North
Delmar
Gardens of
Chesterfield
Delmar
Gardens
West
5.81
4.80
3.83
3.09
2.95
Scenic
Grand
Delmar
NHC, Town
Nursing and Cedarcrest
Manor
Gardens of
Rehab
Nursing and & Country
Manor
Creve Coeur
Center
Rehab
2.82
2.61
2.40
2.38
2.19
NHC,
Desloge
2.13
Alexian
Delmar
Delmar
Brothers Gardens of
Gardens of
Sherbrooke Meramec
O'Fallon
Village
Valley
1.93
1.90
1.90
03/12/2015
Total Hospitalizations by Home February 2015
22
20
18
16
14
12
10
8
6
4
2
0
Delmar
Gardens
on the
Green
Festus
Manor
Delmar
Gardens
West
Delmar
Gardens
North
Delmar
Gardens of NHC, Town
Chesterfiel & Country
d
Scenic
Nursing
and Rehab
Center
Grand
Manor
Nursing
and Rehab
Cedarcrest
Manor
Delmar
Gardens of
Creve
Coeur
Delmar
Gardens of
O'Fallon
Delmar
Gardens of
Meramec
Valley
Delmar
Gardens
South
NHC,
Desloge
Alexian
Brothers
Lansdown
Villaage
Alexian
Brothers
Sherbrook
e Village
Hospitalizations February 15
20
18
16
15
11
9
9
7
6
6
6
5
5
4
2
2
Curr Enr -February 15
123
134
194
140
127
135
114
104
82
98
113
94
115
67
47
37
Transfers Goal
4/5
5/6
7/8
4/5
4/5
5/6
4/5
3/4
2/3
3/4
4/5
3/4
4/5
2/3
1/2
1/2
03/13/2015