1. Think Holistic, Think Patient-Centered,
Think FAST!
Yang Chen, Sara Hanrahan, Cathy Ng, Sophia Olsen
CLARION Case Competition
Spring 2015

2. Overview
● Patient Case
● Root Cause Analysis
● Recommendations & Implementation
● Financial Assessment
● Conclusion

3. Lynette’s Story
Lynette Tate
53 yo Female
Dx: Left hemisphere
ischemic stroke
Disease
Onset
• Low health literacy
• Low awareness of disease prevention
Hospital
admission
• Symptoms-centered care
• Healthcare team lack communication and coordination
Discharge/
Rehab
• Lack proper patient education on disease state and follow-up care
• Lack proper communication between facilities
Homecare
• Failure to receive therapy
• Receiving wrong dosage of insulin
Patient’s Health Decline

4. Stroke
Nationally
● Kills approximately 130,000 Americans yearly
● 4th leading cause of death
● $34 billion each year in costs:
o health care services
o medications
o missed days of work
● 87% of all strokes are ischemic strokes
o when blood flow to the brain is blocked
● The highest death rates from stroke are in the
southeastern US
Kentucky
● Department of Public Health
o William D. Hacker, MD, FAAP, CPE
Commissioner
● Kentucky Heart Disease and Stroke Prevention
State Action Plan 2011-2016

5. Kentucky Heart Disease and Stroke Prevention
State Action Plan 2011-2016
● Kentucky is plagued with the status of
being an unhealthy state.
● It ranks 6th in heart disease and 10th in
stroke mortality.
● Focus on the CDC’s priority areas for heart
disease and stroke.
● The KHDSP Program partnered with the
Northern Kentucky CARE (Cardiovascular
Assessment, Risk Reduction and Education)
o Designed to provide blood pressure
awareness educational encounters
within the community

6. Our Mission
● To deliver care in a holistic,
patient-centered, and
outcome-oriented manner
ensuring accessibility,
reliability, and affordability.

7. Root Cause Analysis

8. Problem:
● Non-optimal care
Patient Factors:
● Low awareness of
disease state/
symptoms
● Diet/lifestyle
● Low health literacy
● Miscommunication
● Lack of education
Provider Factors:
● Not patient-centered
● Partial assessment
● Delayed intervention
● Rushed education
System Factors:
● Non-streamlined care
● Misconception of care
● Lack of care
coordination
● Lack of resources
Community Efforts:
● Low awareness, no
perceived need
● Community
Outreach/Education
● Low overall health

9. Recommendations &
Implementation

10. Patient Factors
Optimal care:
● Help patient to maintain a
healthy lifestyle through
diet and exercise
● Preventive care
Our recommendations:
● Involve patient in their
therapeutic care plan
● Improve patient’s
compliance &
understanding

11. Interventions at Patient Level
● Patient/Family Education
● Use a plain language
● Use teach-back method to confirm patient’s understanding
● Tests and screenings

12. Community Efforts
Optimal care:
● Raise awareness of strokes
and its impact
● Provide professional advice
to the general public
● Encourages the pursuit of
overall wellness in life
Our recommendations:
● Community outreach
and education

13. Interventions at Community Level
● Education focus on the modifiable risk factors associated
with stokes, such as cardiovascular disease, high cholesterol,
smoking, obesity, hypertension, and diabetes
● Wellness fair
● Medication take-back

14. Provider Factors
Our Recommendations:
● Increase interprofessional
communication
● Build trust and foster a good
provider-patient relationship
Optimal Care:
● Patient-centered care
plan
● Interprofessional
communication
● Tailored patient education
● Thorough assessments
● Use of diagnostic studies
● Holistic approach to
patient care

15. Interventions at Provider Level
● Hiring a Stroke Specialist
● “My Care Board”, highlighting: diet status, tests/screenings
yet to be performed, anticipated discharge date
● Multidisciplinary daily rounding
○ Weekly plan of care (POC) meetings
● Interprofessional inservices
● Emphasis on holistic care

16. System Factors
Optimal Care:
● Delivery of comprehensive
health care services that
are well coordinated
● Good communications
among healthcare
providers
Our recommendations:
● Continuity and
Coordination of care
● Follow-
up/Transitioning care

17. Interventions at System Level
● Unified Electronic Medical Record (EMR)
● Having sufficient trained staff for each health
care discipline
● Transfer/Discharge Checklists
● Home evaluations

18. Financial Assessment

19. Why these cost would be good investments?
Initial hospitalization
Rehabilitation
Physician Costs
Hospital Readmission
Medications and other expenses
43%
16%
14%
14%
13%
Breakdown of the direct costs of care for the first 90 days after a
stroke:
Model adopted from The Stroke Center at University Hospital,
Newark, NJ

20. Financial Budget
+ $ 184,864 (Stroke Specialist Salary x 1)
+ $ 61,534 (Occupational Therapist Salary x1)
+ $ 65,388 (Physical Therapist Salary x1)
+ $ 123,750 (Max. EMR Implementation cost)
- $ 110,162 (Aspiration Pneumonia x13)
- $ 428,572 (Readmission Rate Savings / year)
---------------------------------------------------------------------------------------------
$ 103,198 in Savings annually!

21. Contracting Arrangements
Traditional fee for service (Current)
• DRG type payment for the initial hospitalization
• Negotiated fee schedule with providers
Bundled payment arrangement (Alternative)
• Defined amount of money for all of the care

22. Conclusion

23. Stroke in South Tree Health Network
Improve performance related to the Triple Aim:
● Improve the patient experience
o Clinical quality and patient satisfaction
● Improve the health of the population
o Collaborate with Kentucky Action Plan
● Improve affordability of care
o Streamline South Tree Health Network

24. Moving forward...
● Re-assessment of our implementation in 6, 12, 18
months to see if this model is working.
● Replicate/modify this model
for other chronic diseases like
diabetes and hypertension.

25. Questions