Full disclosure, I’m not into video games. However, when I think about chronic disease, it feels like a never-ending fight to win that never ends. So, it fits. As we continue to navigate the home health and hospice world, we need to keep chronic disease at the forefront of making things succeed for patients and for our businesses. Let’s look at taking a step back and analyzing your chronic disease strategy.
Look Closely At Your Agency Numbers:
If you really want to know how you do with chronic disease, then you have to know your client population. Take a look at the following items for your current clients to help you decide your next steps:
- How Many Have A Chronic Disease In The Top 2 Diagnoses? Is it 20% or 80%? It really makes a big difference on your ability to grade yourself on chronic disease care.
- Of Those, How Many Visits Per Episode Were Done? Take a look at your average as well as the variance. Really eyeball those with the same primary diagnosis of a particular chronic disease. Are the number of visits all over the place or is there consistency in the numbers? How many times were you called out for unplanned visits?
- Of Those, Was Chronic Disease A Prime Mover In The Care Plan? Now, we know comorbidity of chronic disease leads to so many other complications. So, how much does a care plan really focus on managing the chronic disease? This is especially pertinent when you consider the chronic disease as a secondary diagnosis. Do you see an intervention or two that are very generic? Maybe there is a goal that really says nothing about how a patient gets better at managing the illness. Does this sound familiar?
- Patient will report any signs and symptoms of exacerbation of CHF.
- Goal: Patient will remain free of exacerbation of CHF x 60 days.
- Check Your Outcomes On These Patients: This is important. We are still an industry that has gotten very good at stabilizing patients- at least on paper. Truly, a lot of those patients are better at managing chronic disease, but our documentation doesn’t show it.
- Deep Dive Into Documentation: Very generic canned interventions often means we didn’t dig into what the patient’s true issue is with managing the chronic disease. Are they too afraid to ask questions? Are they scared to make lifestyle changes? Do they not understand the teaching in the manner it has been done in the past? Do they have a financial or physical roadblock that prevents them from making proper meal choices or obtaining medications? These are all relevant.
What’s Next For Your Chronic Disease Program?
If any of the above stand out to you as a weakness in your program, then you need to decide how to improve it. It begins with the proper and ongoing education to staff. Second is a collaborative care plan with all members of the team managing chronic disease and not just the nurses. Then, it means making sure the approach is patient specific and geared towards attainable and meaningful improvement in the patient’s ability to manage the disease.
Let Kenyon Homecare Consulting Help Change Your Focus:
At Kenyon Homecare Consulting, we have a robust chronic disease educational program called Chronic Disease University. We focus on individual clinician as well as agency wide education. It does no good to educated the individual without an operational plan for change in the organization. call us today at 206-721-5091 or contact us online to see how we can help improve the quality of your chronic disease program. Join us on 10/7/2020 for our free webinar Are You Leaving Money On The Table?