Oregon Flex Program Details
Location: Oregon Health and Science University
Number of CAHs: 25
Web site: http://www.ohsu.edu/xd/outreach/oregon-rural-health/index.cfm
Rural Assistance Center State Resources
Oregon Top Three Flex Activities in 2009
- EMS education – monthly webinars, trauma simulations, leadership
- Quality improvement – benchmarking, TeamSTEPPS, patient safety culture
- Community benefit and financial sustainability for CAHs
Oregon Flex Program Success Story
We have all 25 CAHs involved in our quality network – Oregon Rural Healthcare Quality Network (ORHQN). 20 of these CAHs are sharing data transparently through PMI’s RPM. They are also focused on TeamSTEPPS and recently hosted the first Oregon TeamSTEPPS training adding 37 master trainers in our state.
RPM serves as the platform for a multi-hospital, Acute Myocardial Infarction (AMI) improvement project aimed at improving care in CAH Emergency Departments throughout the state. We will build upon AMI Transfer measures from previous grant years and stay at the forefront of CMS Core Measure and Flex Monitoring Team recommendations for rural appropriate measures. ORHQN recently contracted with PMI to conduct site optimization visits for CAHs using RPM. 12 site visits have been completed to date. The data collected through RPM will help hospitals create a balanced scorecard (BSC) to measure performance and identify areas for strategic improvement. The ORHQN completed an extensive needs assessment to determine which indicators are of most value to benchmark within Oregon. The ORHQN Network scorecard consists of the following indicators: bad debt expense, bad debt percentage, ED wait time, heart failure, patient fall rate, pneumonia, surgical care improvement, patient satisfaction, time to treating provider, and turnover. We will work to address the challenges of accurate, timely and complete data entry.
Another patient safety initiative of ORHQN is extensive training and assistance for CAHs implementing TeamSTEPPS, an evidence-based teamwork system developed by AHRQ and the Defense Department to optimize patient outcomes by improving communication and teamwork skills among health care professionals. ORH sent teams from three CAHs to become master trainers. Three CAHs each sent four key individuals to receive training in Omaha, NE in March 2009. Hospital teams that received direct training consisted of the QI director, Emergency Department (ED) manager, ED physician and one other essential member of the emergency team. Each hospital implemented TeamSTEPPS in their hospital. Oregon’s master trainers just completed a statewide training with eight other hospitals, resulting in 37 additional master trainers in Oregon. ORH will contract with ORHQN to conduct trainings for six additional CAHs in the 2010-2011 grant year. Outcome measures that have been identified include:
- Improved scores on time-to-provider
- Decrease in “left without being seen” ED patient totals
- Improved patient satisfaction scores relating to personal issues, e.g. informed of delays, staff caring attitude, pain control, response to care/concerns and discharge information
- Improved patient outcomes in AMI transfers
- Improved accuracy of patient identification
- Improved employee engagement scores pertaining to staff’s attention to quality
- Improved department score on open communication
- Team-building and improved communication between ED physicians, nursing, respiratory therapy, imaging and lab
The first Oregon CAH to implement TeamSTEPPS has already experienced significant improvement in all of the identified measures as evidenced in the charts and graphs below even though their patient volumes have remained constant.
Oregon Most Significant Flex Achievement
The single most significant achievement of our Flex Program are our Community Health Improvement Partnerships (CHIPs), which are a community-based collaborative designed to facilitate healthcare system development by engaging community members and utilizing qualitative and quantitative health data. CHIP partners include the CAH, solo practitioners, rural health clinics, and federally qualified health centers (FQHCs) as well as community employers and civic leaders. We have conducted year long CHIP processes in twelve communities to date. The projects and momentum in some of those communities are still ongoing and ORH will provide the technical assistance needed to support their ongoing work. ORH will revisit previous CHIP sites to quantify the community and provider level impact that resulted from network activities. ORH will select a minimum of one new CAH community each year to conduct the CHIP process. As highlighted on the map below, selected CHIP activities have included:
- BAKER COUNTY - disease prevention, cancer transportation/support group, affordable health insurance, health education and youth education
- COLUMBIA COUNTY - community control of healthcare resources, expansion of urgent care, provider recruitment and retention, mental health, funding a hospital
- COQUILLE/MYRTLE POINT - children's health, prevention and education, school nurse, transportation, drug and alcohol prevention
- REEDSPORT - health promotion, transportation, affordable prescription drug plan
- LINCOLN COUNTY - county-based health center/FQHC formation, affordable healthcare, healthy community promotion, diabetes prevention, children's health, access to healthcare
- LEBANON/EAST LINN - transportation for seniors, health trail project, health coaching
- MADRAS - quality, affordable healthcare, health promotion, mental health
- BURNS - recruitment & retention, adding school-based clinic, cancer committee
ORH Community Health Improvement Partnership (CHIP) Activity