Pre-COVID Efforts to Improve Home Care Experience Prove Helpful During Pandemic

Added on Jun 4, 2020

masks-cross-medicineSarasota Memorial Home Care: Pre-COVID Efforts to Improve the Patient Experience Enabled Care Continuity During the Pandemic
By Audrey Doyle

When leaders at Sarasota Memorial Home Care implemented changes to improve the care experience for patients and providers two years ago, a global pandemic was certainly not on their radar. Yet the changes proved to be critical elements of the organization’s COVID-19 care delivery playbook.

Part of BayCare Health, Sarasota Memorial Home Care (SMHC) is one of 10 offices comprising BayCare HomeCare, which offers home-based skilled nursing services and disease management to patients residing in 13 counties on Florida’s west coast. In 2018, to improve performance on several Home Health CAHPS (HHCAHPS) survey items and optimize providers’ daily schedules, SMHC revised the way it organized and delivered team-based care. Among the changes were the development of region-specific permanent care teams based on patient and provider location and the institution of virtual multidisciplinary rounds.

Since the implementation of these tactics, SMHC has seen steady increases in HHCAHPS top-box scores. Further, by prioritizing the continuity and coordination of care, these practices have helped leaders manage the disruption to care delivery processes caused by COVID-19 and keep patients and providers safe.

Improving Care Continuity and Coordination

Continuity and coordination across the care continuum are foundational to an optimal patient experience, yet consistently achieving both in the delivery of home-based care can be difficult. Inadequate communication, lack of collaboration among team members, limited follow-up and monitoring, and gaps in services as patients move between care providers and settings can erode the home care experience for patients and providers.

In early 2018, SMHC leaders realized that some of these factors were keeping them from achieving patient experience performance goals established by BayCare. At the time, top-box percentages for the HHCAHPS Rate the Agency, Providers Informed About Care, Communication Between Providers, and Providers Listened Carefully survey items were 77.4%, 60.5%, 81.9%, and 79.8%, respectively—all falling short of BayCare’s 85% target. Patients’ comments indicated they were frustrated that their providers often weren’t well-informed about the care they were supposed to deliver and that they rarely had the same provider from one visit to the next. Consequently, patients had to repeat their health issues or concerns each time they received a home visit, which made them question the quality of the care they were receiving, explained Lisa Orlick, RN, administrator of SMHC.

A meeting with providers revealed additional concerns. Because patient visits were assigned to whichever provider had room on their schedule, provider–patient relationships were almost impossible to establish. Also, it was difficult for SMHC’s close to 50 nurses and nearly 40 physical, occupational, and speech therapists to compare notes on patients in their care. Furthermore, as Sarasota County encompasses more than 550 square miles, providers often had to drive more than 70 miles between patients, which they found extremely frustrating.

To better meet the needs of patients and providers, Orlick and Marla Matteson, HomeCare’s director of shared services and regional director of the Sarasota, Largo, and Bradenton offices, designed a team model organized by territory, where each of 18 territories across three groups is assigned a permanent care team to treat patients in that area. The care teams include two registered nurses and one physical therapist who live in the area. In addition, occupational therapists are shared across groups of three territories, and speech therapists and home health aides are shared across groups of six territories.

Each provider records the details of every home visit on a rounding document that was developed as part of the improvement initiative and participates in daily multidisciplinary rounds conducted via Skype. This ensures that visit information is consistently relayed to the SMHC supervisors, the patients’ physicians, and the provider’s team members. It also eliminates the need for providers to drive to the office and give report in person, which allows them to spend more time on patient care.

These changes have contributed to steady improvements in the office’s HHCAHPS performance. On its most recent survey, the office scored 86.3% for the Rate the Agency global measure, and 70.3%, 85.6%, and 86.4%, respectively, for the Providers Informed About Care, Communication Between Providers, and Providers Listened Carefully to You key drivers. In addition, keeping supervisors up to date on the status of each patient has enabled SMHC to better manage the type of care patients are receiving, contributing to a reduction in its 30-day hospital readmission rate from 12% to 10.6%, according to Orlick. Buoyed by SMHC’s success, the other HomeCare offices now implement variations of these tactics based on their territories’ unique characteristics.

An Unwitting Plan for Pandemic Preparedness

In late winter, when COVID-19 cases began appearing with alarming frequency in the United States, Orlick and Matteson quickly discovered the changes they’d made two years before were giving them a leg up in managing the crisis.

For instance, at this stage of the pandemic, SMHC had numerous patients under investigation (PUIs) for COVID-19 as well as COVID-positive patients. As a safety measure, a Clinician Guidance tool was developed for use by all HomeCare providers whose patients fall into one of these categories. The tool lists procedures to follow when visiting these patients and when using PPE, equipment, and supplies, among other safety guidelines. It also stresses that multiple different providers are not to enter PUI or COVID-positive homes. “With their permanent care teams, Sarasota was already accomplishing that,” Matteson said. “Right away, their patients felt safer knowing it was the same providers coming in.” And because each team and their patients form a “bubble,” if a provider were to contract COVID-19 from an asymptomatic patient, it would be easier and quicker to trace the source.

Being part of a permanent care team also contributed to providers’ care experience early on. “Sarasota was the first HomeCare office to get a COVID patient, but my staff felt protected because their patients were in their territory, so they felt like they knew them. They wouldn’t have felt that way with our old delivery model,” said Orlick. “And if there were exposures, having such tight teams meant we could limit the virus’s spread. The peace of mind this gave to patients, providers, me, and my fellow leaders was priceless.”

Having virtual multidisciplinary rounding in place also factored into providers’ and patients’ safety from the outset. “Not giving report in person limits providers’ interaction with co-workers,” Orlick said. “And because they were already doing the daily Skype calls, they didn’t have to struggle getting used to a new process.”

New Tactics for a New Normal

By early spring, when COVID-19 cases were present in almost every U.S. state, SMHC had begun implementing additional tactics geared toward patient and provider safety. The tactics, which are being followed at other HomeCare offices, include a list of COVID-19 screening questions based on CDC guidelines; a database to track PUI and COVID-positive patients, providers who were in contact with them, and any provider who is symptomatic; and a symptom tracker within the database so that managers, supervisors, and leaders can monitor COVID patients’ symptoms.

In addition, the team has extended its telemedicine capabilities. Prior to the pandemic, SMHC’s telehealth program was limited to patients who were living with a chronic medical condition such as heart failure or COPD. Now, PUI and COVID-positive patients receive telemedicine equipment so that providers can monitor their vital signs, symptoms, and medication in between on-site visits.

At press time, the first wave of the COVID-19 pandemic had begun to ebb slightly. But scientists and epidemiologists were cautioning that another wave may hit the United States in the fall, if not sooner. If it does, BayCare will be ready.

“We’ll keep doing what we’ve been doing while we look for more ways to ensure patient and provider safety,” said Matteson. “This is how home health care should be delivered. If our providers don’t feel safe, they’ll leave the profession. And if our patients don’t feel safe, they won’t welcome us into their homes so that we can give them the care they need in the best place for them to receive it.”