Centers of Excellence Webinar

PowerPoint Presentation: 

Center of Excellence in Continence Care

Centers of Excellence in Continence Care: Goals and Objectives: 

Centers of E xcellence in Continence C are: Goals and Objectives Create a credible, legitimate vehicle to facilitate consumer access to high quality care Establish a fair and transparent process for all applicants, also acceptable to payers and the public at large Remain loyal to our mission as a patient advocate and representative. Own a database of patient satisfaction ratings to create and maintain benchmarks for continuous quality improvement Manage a self-sustaining enterprise, without undue distraction to our ongoing education programs Strengthen NAFC’s reputation as an independent and credible source to guide the consumer in seeking healthcare

Cases gone wrong….unexpected outcomes: 

Cases gone wrong….unexpected outcomes

Proving correct: The whispers among women : 

Proving correct: The whispers among w omen A landmark multicenter study published in 2007: Documented stringently defined success rates – including patient satisfaction scores - of 49% for the Burch and 66% for the fascial sling two years post-op, deteriorating to 22% and 30%, respectively five years out.

PowerPoint Presentation: 

Many Communities Lack Specialty Trained, Experienced Doctors And while the new subspecialty in Female Pelvic Medicine & Reconstructive Surgery, administered jointly by ABU and ABOG, will help with consistent, comprehensive fellowship training, numbers will remain small and largely contained in academic medical centers.

A Growing Interest in Measuring Consumer Perceptions: 

A Growing Interest in Measuring Consumer Perceptions This study surveys over 250,000 households representing over 450,000 consumers in the contiguous 48 states and the District of Columbia. From the households surveyed, 3200 hospitals named by consumers are analyzed and ranked based on their Core Based Statistical Areas (CBSAs) as defined by the U.S. Census Bureau, with the winning facilities being ranked the highest: Top of mind perceptions (image, reputation, advertising recall, etc.) but not detailed, actionable data, especially for multidisciplinary care that may include community providers.

Standards for Patient Satisfaction: 

Standards for Patient Satisfaction Outcomes that fail to meet patient expectations and dissuade consumers from seeking diagnosis and treatment The focus of payers on penalties for NEVER events and readmissions instead of patient satisfaction with quality of care and outcomes Fragmentation , competition, and disagreement among providers as to preferred, evidence-based protocols for diagnosis and treatment Providers lacking experience and/or sufficient surgical training Misdiagnosis Misinformation Poorly executed choices and patient selection for certain procedures The need for costly repeat surgeries and second opinion

PowerPoint Presentation: 

Provider Centered Outcomes Patient Centered Outcomes Pad use Cough stress test Voiding frequency Pelvic floor distress inventory questionnaire Health-Related Quality of Life questionnaire POP-Q system Global impressions of improvement Post-void residual urine volume Improvement in symptoms, including new complications Overall satisfaction, including pain management Confidence in the treatment technology and willingness to recommend to others Cleanliness, ease of navigating, and safety of the facility including signage, parking, etc . Education about one ’ s condition and involvement in treatment plans Satisfaction with quality of nursing care Access to one ’ s doctor for appointment times and dates desired by the patient Adequate preparation by the clinic or discharge nurse for self-care by patient COE: Establishing a New Set of Benchmarks

The COE Requirements: 

The COE Requirements Demonstrated commitment to excellence by upper management, in both clinical services and research. Organization-wide quality improvement and safety initiatives operative. Verification of experience: >150 PFD surgical cases lifetime and >100 surgical cases in the most recent 12 months by each primary operating physician, post fellowship training. An organization, with a Medical Director of the Pelvic Floor Clinic/Department Integrated, full-time, multi-disciplinary team including gynecologists, urologists, colorectal surgeons, gastroenterologists, nurse practitioners, physical/occupational therapists trained in PFD diagnosis and treatment Full line of diagnostic and therapeutic equipment, e.g. urodynamics

The COE Requirements (cont.): 

The COE Requirements (cont.) Fellowship trained PFD surgeons and evidence of ongoing medical society involvement Standardized, clinical pathways and protocols, including perioperative care practice guidelines in writing Formally trained, designated nurses and allied health professionals, e.g., SUNA or WOCN nurse training and certification. Patient education materials in print and online and a demonstrated commitment to community health literacy Means of computerized tracking of all PFD patients for at least two year follow-up data and analysis No litigation pending or in the most recent three years involving patient harm or abuse.

How To Apply: 

Go to www.nafc.org , click on the logo in the lower left corner, and then click on “ Process ” to review the requirements . Make sure you meet case volume requirements. Two or more physicians must apply together, with a hospital where surgeries are performed. Request physician and institutional application forms by contacting memberservices@nafc.org . These must be returned with CVs and an organizational chart illustrating how the Center fits into the clinic ’ s or institution ’ s reporting structure. How To Apply

The COE Application and Review Process: 

The COE Application and Review Process Step #1: Hospital ($1,500) and Physicians ($300 each) submit separate applications Step #2: Surveys are mailed to a sample of patients (95% Confidence Level, +/- 10% Confidence Interval) Step #3: Survey analysis and interpretation: PowerPoint presentation and discussion Step #4: Site Visit Step #5: Report and Recommendation to the Committee Step #6: Designation, Rejection, or 2-Year Provisional Step #7: Three Year Designation ($4,500 hospital fees plus $700 physician fees)

PowerPoint Presentation: 

Month 1 – Obtain and complete applications. Applications are submitted with application fees ($300 MD and $1,500 hospital). Month 2 – Applications reviewed by NAFC, entered in database, and any missing information requested. Month 3 – Applicants generate mailing list of patients and provide to mailing house for NAFC survey. Month 4 – Survey is mailed. Month 5 – Results are tabulated. Site visit is scheduled Month 6 – Site visit takes place. Survey results shared. Month 7 – Full report is written and submitted to Review Committee. Month 8 – Review Committee discusses and issues questions or requests of applicants or approves. Month 9 – Press release is issued. Certificate is shipped for framing and display . Website sections are created. Balance of fees are paid. Timeframe for Completing Application Reviews and Center of Excellence Designation

Patient Survey Structure: 

Patient Survey Structure Overall Patient Experience and Health Status Following Treatment Patient Satisfaction with Facility (including scheduling, nursing staff, check-in, discharge, etc.) Patient Satisfaction with Physician (including evidence of shared decision-making)

Two-Day Site Visit Itinerary: 

Two-Day Site Visit Itinerary Each Applicant Physician Administrative Manager Nursing Supervisor, Clinic Nurses Physical Therapist Collaborative Physicians (e.g., Colorectal Surgeon) Research Nurse Coordinator Sr. VP Operations for the Facility/COO/CEO Manager of Contracting Services Director of Marketing and Media Relations Department Chairman Pelvic Floor Clinic Medical Director Patient Ombudsman/Patient Guest Services Nurse Practitioner – Patient Education or Pessary Specialist

Final COE Designation: 

Final COE Designation

Publicity of Centers of Excellence in Continence Care: 

Publicity of Centers of Excellence in Continence Care

The 2012 Review Committee: 

The 2012 Review Committee Holly Richter, MD, PhD (UAB) Kathleen Kobashi, MD (Virginia Mason) Willy Davila, MD (Cleveland Clinic) Cheryl Iglesia , MD (Washington Hospital) Tracy Hull, MD (Cleveland Clinic) Peter Lotze , MD (OBGYN Associates) Sal Giorgianni, PharmD (Retired) Nancy Hicks (Ketchum)

End of COE Portion of Presentation: 

End of COE Portion of Presentation Questions?

Mission of the organization : 

Mission of the organization As one of the world’s largest, oldest, and most prolific public education and patient advocacy organizations in the field, it is NAFC’s mission: 1 ) to educate the public about the causes, diagnosis categories, treatment options, and management alternatives for bladder and bowel control problems, voiding dysfunction and related pelvic floor disorders; 2) to network with other organizations and agencies to elevate the visibility and priority given to these areas; and 3) to advocate on behalf of patients who suffer from such symptoms as a result of disease or other illness, obstetrical, surgical or other trauma, or deterioration due to the aging process itself. NAFC is broadly funded by consumers, healthcare professionals and industry.

Constituency Served: 

Constituency Served Men, Women, and Older Children and Teens Young mothers Young adults who have sustained SCI accidents People with neurological diseases and conditions (PD, MS, stroke survivors, etc.) The elderly and infirmed Menopausal women Post-prostatectomy men

NAFC Programs and Activities: 

NAFC Programs and Activities Website traffic: >40,000 monthly Printed patient education materials

NAFC’s Advocacy Voice: 

NAFC’s Advocacy Voice Urging FDA approval of new, advanced medications and devices to give patients access to proven, advanced technology…and sustain their hope Urging AMA to assign discrete codes to new products Urging CMS and private payers to provide coverage and reimbursement of treatment options

Helping Consumers Find An Expert: 

Helping Consumers Find An Expert Consumers are increasingly distrustful of health information online: Competing sources of information use different metrics, methodologies and data sources, fielding contradictory and confusing quality data Word of mouth (50%) and physician referrals (38%) still drive the majority of doctor selection by consumers, especially when choosing specialists or facilities for medical procedures. Two in five rely on multiple sources. Only 3-11% rely on online provider databases.

Influential Trends: 

Influential Trends The call for improving safety (IOM, 1999) Growing focus on patient centered healthcare Application of evidence-based healthcare (“Not about us without us”) Shifting more costs and responsibility for self-care onto the patient

PowerPoint Presentation: 

Center of Excellence in Continence Care