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Improving Communication in Home Based Primary Care

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To provide the Veteran with more timely access to care, as well as the reassurance that their care team is working as a cohesive unit to address their concerns and resolve their needs.

This innovation is emerging and worth watching as it is being assessed in early implementations. See more emerging innovations.

Adoptions:

1 successful

Awards and Recognition:

James H. Quillen VAMC HeRO Award June 2022, Recognized by VISN 9 Continuous Readiness Review (CRR) Team May 2022 as highest performer for Quality Improvement within VISN 9 Geriatr ... James H. Quillen VAMC HeRO Award June 2022, Recognized by VISN 9 Continuous Readiness Review (CRR) Team May 2022 as highest performer for Quality Improvement within VISN 9 Geriatrics and Extended Care

Partners:

Geriatrics and Extended Care, Office of Rural Health

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Overview

The problem

Throughout the pandemic, Home Based Primary Care (HBPC) experienced challenges with effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and patients, as well as consistent ... See more

Images

Home Based Primary Care Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Summary Reports: Patient Satisfaction Score for “Communication Between Providers and Patients” decreased from 86.30% Q2FY20 to 81.20% Q2FY21, resulting in a patient satisfaction ranking within VA Facilities for Communication Between Provider & Patient to the 40th percentile. Note: the term “provider” is not inclusive to the physician and/or the Nurse Practitioner. but to any HBPC team member.

Current State Before Project

Videos

Improving Communication in Home Based Primary Care (video created by Lee Liguore)

The solution

After assessing deficiencies in communication between the Veteran and the HBPC team, as well as between the HBPC team members, the workgroup streamlined the phone calls coming into HBPC, developed a Wellness Checkup tool to guide Veterans and caregivers as to when and how to contact their team, and created a standardized tool for how the clerical staff shoul ... See more

Images

Wellness Check-Up Tool. A tool for screening Veteran's status used by the Veterans and their caregivers in monitoring their level of wellness as well as any signs and symptoms they should report to their HBPC care team. The colorful stop light visual indicates when all is well (green), when they should call their care team (yellow) and when they should call 911 or go to the Emergency Room (red).

Wellness Check-Up Tool

HBPC Incoming Call CPRS Alert Notification Guide. This guide is used to direct frontline staff, mostly Program Support Assistants (PSAs), in how to disposition calls based on the Veterans and/or Caregivers voiced needs. It includes a trigger list of signs, symptoms and incidences that should be immediately transferred to the Telephone Triage RN, a guide for emergent mental health crisis calls, and a disposition tree for all other needs that indicates which discipline needs to receive the view alert for the particular request.

HBPC Incoming Call CPRS Alert Notification Guide

The results

Improving communication within the HBPC team directly impacts the Veterans and caregivers served. The implementation of standardized processes resulted in the disposition of calls being sent to the team member who could most efficiently address the problem. This provided the Veteran with more timely access to care, as well as the reassurance that their care ... See more

Images

HBPC Satisfaction Survey: Communication Between Providers and Patients scores are pulled using the VSSC HBPC Patient Satisfaction Survey Report. During Q4FY20, the facility was at 81.3%. This score is tracked using a line graph with the last data point available revealing an improvement to 83.9% Q4FY21. Ongoing monitoring is planned quarterly. Additionally, this report reveals the ranking of our facility in comparison to other VHA facilities for the particular metric. James H. Quillen VAMCs HBPC ranking was 40th percentile Q4FY20. This score is tracked using a bar graph with the last data point revealing an improvement to 73rd percentile Q4FY21.

The quarterly chart audits revealed that HBPC incoming calls were correctly dispositioned 45.5% of the time (prior to process improvement). Use of a split bar graph has enabled us to track improvements with the last chart audit revealing an improvement to 89.3% of incoming calls being correctly dispositioned.

Confirmed State- Outcomes

Patient Satisfaction Scores: Communication Between Provider and Pts thru FY22Q2 and Incoming Call Disposition Accuracy Rates Thru FY22Q4

Follow Up Data-Maintenance

Metrics

  • HBPC Satisfaction Survey: Communication Between Providers and Patients scores are pulled using the VSSC HBPC Patient Satisfaction Survey Report. This report reveals the ranking of our facility in comparison to other VHA facilities for the particular metric. James H. Quillen VAMCs HBPC ranking was 40th percentile Q4FY20. This score is tracked using a bar graph with the last data point revealing an improvement to 73rd percentile Q4FY21. Additionally, during Q4FY20, the facility was at 81.3%. This score is tracked using a line graph with the last data point available revealing an improvement to 83.9% Q4FY21. Ongoing monitoring is planned quarterly.
  • The baseline quarterly chart audits revealed that HBPC incoming calls were correctly dispositioned 45.5% of the time (prior to process improvement). Use of a split bar graph has enabled us to track improvements with the last chart audit revealing an improvement to 89.3% of incoming calls being correctly dispositioned.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

  • 2-4 weeks
    Consolidate all incoming HBPC telephone lines into one main number.
  • 2 months
    Replicate standardized tool for how to disposition incoming telephone calls.
  • 2 months
    Replicate “Wellness Check-Up Tool” for Veterans/caregivers to use as a guide for when, how and why there is a need to contact their HBPC Team.
  • 2-4 weeks after completion of tools
    Educate all HBPC staff on new communication tools.
  • 2-4 weeks after completion of tools
    Disseminate "Wellness Check-Up Tool" to all currently enrolled Veterans by mailing the tool and enclosing a letter that explains the reason for tool, how the tool is used and recommendations for posting it in their home for quick access (recommended posting on refrigerators/another location that is easily accessible on a daily basis).
  • Within 6 weeks after "Wellness Check-Up Tool" mailed to Veteran
    RN Care Manager will follow-Up and complete in-person education on the tool with the Veteran and/or caregiver.
  • Before Initiating Project and Quarterly After Completion
    Chart audits on clerical staff intake and disposition of incoming calls.
  • Post Education on Tools and Quarterly
    Follow up with staff via email on utilization of both tools to solicit feedback on their effectiveness and/or issues.

Departments

  • Extended care and rehabilitation
  • Education and training
  • Quality control
  • Information technology

Core Resources

Resource type Resource description
PEOPLE
  • Home Based Primary Care Telecare RN- Full Time 40 hrs/week
  • Program Support Assistant (PSA)- Full time 40 hrs/week
  • Patient Education Coordinator or Committee to review/approve tool - 2-4 hrs
  • Information Technology for assistance with phone lines, 1-2 hours
PROCESSES
  • Wellness Check Up Tool duplication, dissemination to all HBPC Veterans, education completed by RN Care Manager
  • HBPC Incoming Call Disposition Tool creation, educate all clinical and administration staff initially. Follow up quarterly regarding issues and to adjust based on feedback.
TOOLS
  • Wellness Check up Tool

Files

  • This guide is used to direct frontline staff, mostly Program Support Assistants (PSAs), in how to disposition calls based on the Veterans and/or Caregivers voiced needs. It includes a trigger list of signs, symptoms and incidences that should be immediately transferred to the Telephone Triage RN, a guide for emergent mental health crisis calls, and a disposition tree for all other needs that indicates which discipline needs to receive the view alert for the particular request. HBPC Incoming Telephone Call Disposition Guide
  • This tool assists Veterans and their caregivers in monitoring their level of wellness as well as any signs and symptoms they should report to their HBPC care team. The colorful stop light visual indicates when all is well (green), when they should call their care team (yellow) and when they should call 911 (red). HBPC Wellness Check Up Tool

Optional Resources

Resource type Resource description
PROCESSES
  • Lean Processes and System Redesign Tools
TOOLS
  • VHA issued computer and software resources including Microsoft Word, PowerPoint and Excel; VISTA, CPRS.
  • Print Shop Resources on site to print laminated “Wellness Check Up Tool”.
  • IT support.
  • Space for key positions if telework is not approved.

Risks and mitigations

Risk Mitigation
Staff Buy-In Buy-in from frontline clerical staff and HBPC administration is important. To mitigate this barrier, include the frontline staff in creating the tools and finding solutions for the deficiencies and seek approval from program and leadership at the when the project charter is initiated.
Lack of Designated Telephone Triage RN Use of a RN that is on light duty due to injury or who needs a Reasonable Accommodation related to a disability or vaccine status.
Lack of Printing Program/Department Use of colored printer and purchasing of laminator. Program Support Clerk staff can be utilized to print and laminate Wellness Check-Up Tool.
Space for Key Staff: Program Support Clerk & Telephone Triage RN Telework agreements if space unavailable.

Contact

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About

Origin story

Throughout the pandemic, the James H. Quillen VAMC Home Based Primary Care (HBPC) program experienced challenges to effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and ... Throughout the pandemic, the James H. Quillen VAMC Home Based Primary Care (HBPC) program experienced challenges to effective communication due to remote working, staffing shortages, employee and Veteran stress, and fragmentation in workflow processes. These challenges resulted in declining patient satisfaction scores for communication between providers and patients as well as consistent complaints from staff regarding poorly dispositioned incoming telephone calls. The team set out to address these deficiencies to make improvements in both Veteran experience and staff satisfaction.

Original team

Angela Hope Ledford MSN, RN

Program Director HBPC

Kelli Jones MSN, RN, CDCES

Nurse Manager, HBPC

Dr. Bryan Watson

Medical Director, HBPC

Rebecca Haynes BSN, RN

RN Care Manager

Shannon Rider MSN, RN

Telecare RN

Ruth Quejada MSN, RN, CNL, CCRN

RN Care Manager

Larry "J.R." Wilkins

PSA

Torrey McClurg

PSA

Debbie Smith-Sisto

PSA

Dr. Daniel Bulger

Clinical Pharmacy Specialist