Among the many things changing in the long term care landscape is the nature of partnerships among health care providers. Back in the day, long term/post-acute care (LT/PAC) representatives would bring pies and donuts to build and nurture relationships with acute care providers.

 

While relationships are still important, today those driving acute care referrals to LT/PAC facilities want to see pie charts: data that quantify the quality of care and outcomes delivered by the facility.

The ability of long term care providers to quantify outcomes continues to evolve.

First, the data required to calculate various quality and outcome measures have to be collected in a consistent way so that meaningful analysis is even possible. Second, the data cannot be held hostage; they must be stored in a system where they are accessible by business intelligence tools, or analytics, that can perform the calculations and present the data in a way that they can be easily understood. While many providers are collecting data, the completeness of the data set and the ability to access and analyze it is still problematic, so the focus still tends to be on solving these two problems.

That being said, forward-looking providers have their eyes on the real prize, the ability to use data to impact outcomes.

They see the opportunity to go beyond reporting what happened yesterday, to understanding why it happened, to making changes to manage outcomes in the future, and, ultimately, to using predictive analytics to anticipate and prevent negative outcomes. Managing outcomes requires effective root cause analysis and systems to support the process.

Root cause analysis is one component of the quality management PSDA (plan, do, study, act) model for improvement. The objective of root cause analysis is to investigate the cause of a problem and apply the following principles:

■ Determine what happened or identify the cause of a problem;

■ Determine why it happened; and

■ Figure out what to do to reduce the likelihood that it will happen again.

Root cause analysis consists of six steps:

Step 1.    Organize the team: Who will conduct the investigation?

Step 2.    Define the problem or issue.

Step 3.    Conduct data analysis: Collect and analyze the data.

Step 4.    Determine root cause(s): Use “The 5 Whys,” or fishbone, diagram.

Step 5.    Improvement planning: Create solutions linking root cause with improvement activities. Implement the solution.

Step 6. Evaluate progress: Evaluate if the intervention is working.

Although all steps are necessary, two key areas of focus include accurately defining the problem and gathering the appropriate data for analysis. The electronic health record (EHR) is a valuable tool in collecting and analyzing the structure, process, and outcome measures associated with identified problems or issues.

Each organization should determine the measurements that will be monitored for the associated problem or issue. For example, the figure above illustrates the relationships between the structures, processes, and outcomes for falls management.

Analytics converts the numerous pieces of structured data within an EHR into meaningful information used for outcome management. The quality team completes Step 4 of the root cause analysis process, using this information as a guide.

Once the root cause is determined, the team implements the new solutions. Analytics is used again in
Step 6 to evaluate the success of the implemented interventions.

An effective outcome management process is the new standard by which LT/PAC organizations are measured. Future health care partnerships are reliant upon the organization’s ability to demonstrate successful outcome management, and using technology to gather and analyze data is required for efficient outcome management. Powerful analytics, included as a component of a complete EHR solution, is the tool that will give providers a competitive advantage.

Analytics, through the use of dashboards, provides information sought by partners in an understandable and visually impactful way.

Participants of accountable care organizations will also expect their partners to present objective measures that quantify the quality of care and outcomes they deliver. Health care partners will place a premium value on organizations that can demonstrate their use of analytics to impact the quality of care provided and resident outcomes.

Denise Wassenaar, RN, MS, LNHA, chief clinical officer of MatrixCare, is an evidence-based practitioner experienced in innovative approaches to the delivery of care, including more than 20 years of clinical leadership experience. Wassenaar is a nursing home administrator and holds a master’s degree in nursing. She is a frequent presenter on current clinical and regulatory topics.