Interdisciplinary Staff Education for COPD

Using Standardized Patient Education

Kathy Calandra, RN, BSN, CPHQ Healthcentric Advisors

Jennifer Cellar, CNP, Medical Associates of RI/St. Elizabeth Manor

Mary Biello, RN, BSN VNA of Rhode Island

This material was prepared by the New England QIN-QIO, the Medicare Quality Innovation Network-Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSRI_C3-1_052716_0576

Outline

Greater Providence Community Coalition’s Selection of A Safe Transitions Initiative

Developing Tools and Training

Measures, Data and Results

Spread

2

The Community Coalition

3

The Community Coalition

4

Greater

Providence

Community

Coalition

The Community Coalition

Greater Providence Community Coalition

• Background, state of coalition August 2014

• Kick Off 11th SOW

• Annual survey

5

The Community Coalition

Selection of First Initiative

• Discussed ways to increase attendance

• Disease focus

• Heart Failure (HF) Initiative 2013 – a

model

6

The Problem Identified

7

The Problem Identified

• Goal established by coalition chairs:

– Provide consistent, standardized messaging

to patients across care settings

• Proved to be the ticket to increased coalition engagement!

8

Available Knowledge

• IRB approved HF study 2013 showed significant reductions in readmissions

• Literature Search

– Success with proper patient self management

– Whole system approach key

– Use of Zone Tools/Action Plans

9

Developing the

Tools & Training

10

Selection of Patient

Teaching Tools • Reviewed available tools in use by multiple

providers

• Lung Talk Books and Videos

• UCONN Health

• Implementation

11

Selection of Patient

Teaching Tools COPD

Action Plan

COPD

Symptom Tracking

12

Support for Selection of

Teaching Tools

Pulmonologist Office supported the choice

American Lung Association

Better Breathers Support Group

13

Train-the-Trainer Program

Development • Survey to gauge interest and gain commitment

• Champions

– Ensure program adaptable to various settings

and staff

– Feasibility

14

Train-the-Trainer Program

Development

15

Program content, designed for licensed

clinical and supportive staff:

Tools provided to ensure all trainers have

the necessary resources for success:

Standardized Lung Talk education Training Manuals

Strategies to engage patients and families in disease self-management

Pre- and post- knowledge tests with answer keys for measurement

Strategies to reduce preventable hospital readmissions for COPD population

Lung Talk Video Links

Symptom tracking and action plans Standardized education tools

Motivational interviewing techniques Slides for teaching

Use of “teach back” methods Instructions and tools for data collection

Lung Talk Videos (along with pre and posttests) Inhaler samples

Medication Delivery Systems Other Resources, including identified “champions” from each care setting

Medication Delivery

Systems Diskus

• Holding the diskus, put the thumb of the other hand on the thumb grip, sliding until it clicks (keep horizontal from this point)

• Breathe out

• Place mouthpiece in mouth and seal with lips

• Breathe in deeply, hold breath for 10 seconds and exhale

**Advair, Flovent

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Measures, Data & Results

17

Measures and Ensuring

Data Collection

• Commitment included responsibility for data collection

• Simple tools were developed and were included in the content of the Train-the-Trainer Program

• Data collection reinforced at all coalition meetings

• Incentive to receive additional materials

18

Measures and Ensuring

Data Collection • For Staff – Proximal Outcome Measures:

– Rate of staff training towards goal

• Total # of staff trained across all participating organizations/Total # of staff identified as appropriate for training

– Outcome of training

• Rate of improvement pre and post test results

19

Results: Train-the-Trainer Participation

Participating Organizations

Acute Care Hospitals 6

Nursing Homes 16

Home Health Agencies 5

Physician Offices/PCMH 7

Other 7

20

Results: Spread of Training

Completion of staff training across wide spread multiple settings out of the total identified to receive training.

0%

20%

40%

60%

80%

100%

Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

21

Results: Spread of Training

Increase in knowledge was observed among all who received the intervention, both the Master Trainers and staff trained by Master Trainers.

22

Results: Impact on Patients

• Limitation of Initiative

– No proximal outcome data for patient outcomes

– CMS Claims Data to calculate COPD readmissions rates is 6 months behind

• Rhode Island Hospital’s contribution

23

Results: Impact on Patients

24

Spreading the Program

Across Rhode Island

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Phase II of Initiative: Plan-Do-Study-Act (PDSA)

• Survey to participants 3 months after implementation

• Meeting with small group of Master Trainers to plan improvements

– Strengths identified:

• Training manual had everything they needed for staff trainings

• Lung Talk Books and Video Links useful for teaching staff, easy to explain

• COPD Zones and Action Plan tool easy to explain

• Inhaler samples very useful

26

Phase II of Initiative: PDSA

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Opportunities to Improve Action Taken for Phase II

Length of trainings offered by

Master Trainers were running over

1 hour

Streamlined the training outline,

made some videos optional

Pre and Post Tests too lengthy

Questions were reviewed and some

eliminated to make the tests 10

questions only

Phase II of Initiative: PDSA

• Reported on Progress of the Greater Providence Coalition’s COPD Initiative at all 4 coalitions’ meetings

• External presentations on progress at stakeholder meetings (Lifespan, BCBSRI)

• Checked state-wide interest in Phase II Train-the-Trainer Program with survey

• 3 Train-the-Trainer Sessions April 27th -May 3rd

28

Summary of

Spread of Initiative • 62 participants at Train-the-Trainer in April/May

• 29 organizations added

• Total “Master Trainers” around the state =137

• Total participating organizations = 70

29

Key Findings and

Strengths • Development and implementation of a

community wide, standardized COPD education for patients is a realistic means to provide COPD self-management education across settings of care.

• Train-the-Trainer participants and their trained staff increased their COPD knowledge through the program

30

Key Findings and

Strengths, continued • Community buy in and collaboration

• Materials & Resources adopted by many providers

• Commitment to Collecting Data to measure and to be a part of the outcomes

• Behavioral Health spread

31

Key Findings and

Strengths, continued

And finally – the initiative addressed the Gap:

Patients overwhelmed with various

resources in multiple settings now can

receive standardized messaging and tools.

32

Success Made Possible

by... • Train-the-Trainer developers and presenters

from Leadership of our Coalitions

• Our sponsors

• Our coalition participants committed to the triple aim

33

Questions?

34

Contact our Team

This initiative is being submitted as a SQUIRE to CMS. References available.

• For further information, contact:

Kathy Calandra - Healthcentric Advisors Safe Transitions Lead for RI

kcalandra@healthcentricadvisors.org

Jennifer Cellar, CNP - Medical Associates of RI/St. Elizabeth Manor

jcellar@stelizabethcommunity.org

Mary Biello - Clinical Liaison VNA of Rhode Island

mbiello@vnari.org

35

View the tools on our website:

www.healthcarefornewengland.org/event/in-person-event-all-ri-community-coalitions-copd-train-the-trainer-sessions/