Health Services Advisory Group, Inc. Health Services Advisory Group, Inc. Performance Improvement ProjectsPerformance Improvement Projects

Nursing Home Diversion ProgramNursing Home Diversion Program

Where Are We Now?Where Are We Now?

Concurrent Breakout Session #2Concurrent Breakout Session #2Florida EQR Quarterly MeetingFlorida EQR Quarterly Meeting

June 18, 2008June 18, 2008

Presented by:Cheryl L. Neel, RN, MPH, CPHQManager, Performance Improvement Projects

Study Topic

Retention Rate was chosen as a collaborative PIP for the NHDPs. Without the services provided by the NHDPs, the enrollees would have no choice but to receive care in an institutional setting such as a nursing home. The goal is to maintain the enrollees in the least restrictive environment.

Study Question

Will interventions by NHDP case managers result in an increase in retention rates of Diversion enrollees?

Study Indicator

Numerator:

Number of enrollees in the denominator who were still enrolled with the NHDP at the end of the measurement period.

Denominator:

Number of enrollees enrolled in the NHDP at any time during the measurement period.

Study Population

Synopsis of study population:• All Diversion enrollees will be included in

the study.• Enrollees will not be identified by age or

gender.• Enrollees will be excluded from the

denominator if they were involuntarily disenrolled during the measurement period. Disenrollments are identified as (not inclusive) death, not eligible for Medicaid, etc.

Study Population

Synopsis of study population (continued):• Enrollees will be included if they are

continuously enrolled for at least one month during the measurement period.

• One two-month gap is allowed during the measurement period.

Where are you now?

Questions and Answers

Where Are We Going?Collaborative NHDP PIP

Improving Retention Rates

Debbie Lynott,

American Eldercare, Inc.

June 2008

What Are Our Goals?

• PIP by individual diversion contractors?

• PIP with group data of all diversion contractors?

• PIP with both individual and group data of all diversion contractors?

Why Do Members Voluntarily Disenroll?

• Moving to out-of-network nursing home

• Moving to an out-of-network ALF

• Transferring to a new provider

• Dissatisfied with services

• No longer wishing to participate in diversion program

Defining the Disenrollment Reasons?

• Moving to out-of-network nursing home

• Moving to an out-of-network ALF

• Transferring to a new provider

• Dissatisfied with services

• No longer wishing to participate in diversion program

Moving to an Out-of-Network SNF

Internal Factors:

• Diversion contractor can not agree to rates

• Diversion contractor does not want to contract with the SNF

• SNF refuses to contract based on a previous problem with the diversion contractor

• Other?

External Factors:

• Nursing home refuses to work with diversion contractor

• Diversion contractor identified that the member could be cared for safely in a less- restrictive environment

• Other?

Moving to an Out-of-Network ALF

Internal Factors: External Factors:

Transferring to a New Provider

Internal Factors: External Factors:

Dissatisfied with Services

Internal Factors: External Factors:

No Longer Wishing to Participate in Diversion Program

Internal Factors: External factors:

Designing a Data Collection Form (Example)

DATA COLLECTION FORM–DIVERSION COLLABORATIVE STUDYRETENTION RATES

  To be completed by assigned diversion employees after the disenrollment form is received. This form must be completed and submitted to ___________Dept. for all voluntary disenrollments.

Moving to an out-of-network SNF (pick one of the reasons below)1. Diversion contractor cannot agree to rates2. Diversion contractor does not want to contract with the SNF3. SNF refuses to contract based on a previous problem with the diversion

contractor4. Nursing home refuses to work with diversion contractor5. Diversion contractor identified that the member could be cared for safely in

a less-restrictive environment6. Other ____________________________________________________

Health Services Advisory Group, Inc. Health Services Advisory Group, Inc. Performance Improvement ProjectsPerformance Improvement Projects

Nursing Home Diversion ProgramNursing Home Diversion Program

Developing a Data Analysis PlanDeveloping a Data Analysis Plan

Concurrent Breakout Session #2Concurrent Breakout Session #2Florida EQR Quarterly MeetingFlorida EQR Quarterly Meeting

June 18, 2008June 18, 2008

Presented by:Cheryl L. Neel, RN, MPH, CPHQManager, Performance Improvement Projects

Activity 8. Data Analysis and Interpretation

Evaluation Element 1.

The data analysis is conducted according to the data analysis plan in the study design.

Data Analysis Plan

What is the importance of a data analysis plan?

Answers: 1) A data analysis plan outlines how

you will statistically answer your study question.

2) By developing a data analysis plan before you collect data, potential data issues may be avoided.

Data Analysis Plan

What questions will help in the development of a data analysis plan?

Answers: 1) Are the study indicators broken down by

age, county, or region?2) What type of statistical testing am I going

to use?3) With a rate, am I going to report the

numerator and denominator?4) With a mean, am I going to report out the

standard deviation, the minimum, and the maximum?

Data Analysis Plan

Answers (continued): 5) Is it best to use a graph to display the

results? or

6) Is it best to use a table to display the results?

7) What statistical test am I going to use to compare my baseline to remeasurement?

Data Analysis Plan

What are the final steps in creating a data analysis plan?

Answer:

Once all the above questions have been answered, organize your answers into a plan that clearly outlines each step of your analysis and how the results will be presented.

Data Analysis Plan

Short example of a data analysis plan:

“Retention rates for all NHDP enrollees will be analyzed. The rates will be displayed in tabular format including numerators and denominators. Chi-square statistics will be calculated, as well as p values indicating differences between baseline and measurement years. The p values indicating a statistically significant change will be bolded with an arrow indicating which direction the change occurred.”

Questions and Answers