The facilities and programs of PCC offer a 'hidden jewel' in their midst - a robust and sophisticated Outcomes Measurement program that is integrated with the Quality programs at Partners.

With oversight from the PCC Patient Care, Quality and Compliance Committee, this outcomes measurement program includes regular monitoring and reporting of close to seventy (70) different measures, including:

• Patient Falls
• Hospital Acquired Pressure Ulcers
• Functional Outcomes
• Patient Satisfaction
• Pain Management
• Discharges to the acute setting
• Numerous IT Measures, including eMAR, Smart Pumps and LMR

In addition to the monitors for the PCC Quality Committee, each facility and service line tracks specific activities including Medication errors, Reaction to Blood Products and Environment of Care measures. Individual facilities have reporting requirements to the Department of Public Health, Board of Registration in Medicine and to the Joint Commission.

More important than the measures themselves, however, are the actions that are taken in response to the data. Some examples include:

• In response to an increase in pressure ulcer frequency, a PCC facility created a Skin Care and Management program which included staff training by CWON, increasing frequency of checks and documentation, and replacing bed mattresses with new pressure redistribution mattresses. The program was piloted on one unit and then expanded to include all floors; results show a decrease in the number of acquired pressure ulcers.
• After CPOM was implemented at a PCC facility, it was discovered through regular monitors that the existing screen for physician determination of anticoagulation was inadequate; the Pharmacy Director created a new screen for Warfarin Therapy by Pharmacy protocol.
• As a response to a number of measures, a PCC rehabilitation facility implemented a multidisciplinary patient rounding system that includes RNs, CNAs, physical, occupational, speech and respiratory therapists. At each rounding visit the staff member checks on the patient's need for toileting assistance, pain medication and personal items. Preliminary results show a reduction in call-light use, fewer falls, reduction in pressure sores, and increased patient and staff satisfaction.
• As a result of tracking falls data, PHC implemented a baseline assessment of all patients' ambulation status called Timed Up and Go (TUG). This has resulted in a decrease in falls over the last 2 years and improvement in the Home Health Compare locomotion scores.

PCC also can boast outcomes that are better than national standards. One of the important measures in post-acute care is functional outcomes, or simply how much improvement the patient made after receiving post-acute services.

This is important because it measures the effectiveness of the services provided. Combined with length of stay (or duration of treatment), one can measure the efficiency of post-acute services.

2009 Functional Outcomes- Stroke Program

	Number of Patients	FIM Change	FIM Efficiency
Spaulding Rehab	590	32.8	1.96
Nation	95,095	25.0	1.70
Rehab Hospital of the Cape and Islands	211	25.9	1.84
Nation	32,187	21.26	1.50

This data shows that both Spaulding and RHCI Stroke programs help patients to progress farther, in a shorter period of time as compared to the nation. This is particularly impressive given the complexity of many of our patients within the Partners system.

Another important measure for the PCC LTAC facilities is Ventilator patient outcomes. As there is no standardized measurement system for Vent patients, the LTAC facilities use their own tracking system, but can compare their performance to national benchmarks.

SKRH Ventilator Program Outcomes

	Number of Patients	Weaned	Discharged to Community
SKRH	109	58%	42%
NALTH study1	1419	54%	29%

¹Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals: A Multicenter Outcomes Study. Chest 2007; 131:85-93

Partners Home Care (PHC) also tracks patients' functional improvement using a system called Home Health Compare. Looking at a sampling of measures from the comprehensive assessment system, PHC does better than the nation in many areas:

2009 Home Health Compare

	Ambulation/Locomotion	Oral Meds	Dyspnea	Re-hospitalization
PHC	52	54	70	27
Nation	46	43	60	29