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Tech4Impact Grantee, Texas Department of Aging and Disability Services, Completes CTA Grant Project with Demonstrated Cost Savings

2/29/12 By David Lindeman

The Texas Department of Aging and Disability Services (DADS), a CTA Tech4Impact grantee, implemented The Care Transitions Coaching Tool to facilitate the delivery and evaluation of the Care Transitions Intervention® (CTI). CTI is a care management strategy that is increasingly being used to successfully improve care following hospitalizations and to prevent avoidable rehospitalizations. The Care Transitions Coaching Tool, using an ACCESS database platform, was developed based on feedback from multiple stakeholders delivering the Care Transitions Intervention® in hospitals and community-settings. Use of the tool has resulted in a savings of up to 20 hours per week of a care transition coach’s time and up to 19 hours per week of supervisor time, which translates into a savings of approximately $969/week in personnel costs.

WHO WAS INVOLVED?

Scott & White Healthcare in collaboration with the Central Texas Area Agency on Aging and the Texas Department of Aging and Disability Services

WHAT THEY DID

Problem Addressed: When evidence-based interventions are disseminated in community settings outside the realm of research protocols and evaluation, it can be difficult to capture information needed to evaluate fidelity to the original intervention and the impact of the intervention in real- world settings. This innovation emerged out of a need to enhance data collection for evaluation processes and outcome measures of hospital and community-based implementation of the Care Transitions Intervention® (Coleman et al., 2004; Coleman et al., 2006; Parish et al., 2009). The challenge was to include the enhanced data collection and evaluation components without introducing undue demands on transition coaches’ time.

Patient Population: Any hospitalized adult population

Description of the Innovative Activity: The Care Transitions Coaching Tool was developed based on feedback from multiple stakeholders delivering the Care Transitions Intervention® in hospitals and community-settings, including coaches in the field, supervisors, and evaluators at several sites. A publicly available version of the tool, the “Coach database,” was used as a starting point for creation of the Care Transitions Coaching Tool.

The Care Transitions Coaching Tool runs on individual computers or as a shared file on a local server. Data is stored using methods that allow for analysis by an individual coach for a particular case, as aggregated data for reports for project managers, or extracted as raw data for evaluation purposes. Both process and outcome measures can be captured with the tool.

DID IT WORK?

Summary of Results: For sites that do not currently have systems in place to track delivery of interventions, the tool is both useful and cost-effective.

  • The Care Transitions Coaching Tool promotes easy integration of coaching activities, data capture, project management, and evaluation functions without disruption of the fidelity of the intervention.
  • Coaches found the Care Transitions Coaching Tool user-friendly and reported an enhanced ability to adjust coaching techniques to better meet individual and program goals.
  • In 2011, the Care Transitions Coaching Tool was shared with more than 35 sites in at least 21 states (Alabama, Alaska, California, Colorado, Florida, Hawaii, Illinois, Indiana, Kansas, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Texas, Virginia, Washington, and Wyoming.) At the end of 2011, six sites had implemented the tool to support the delivery of the Care Transitions Intervention®.
  • The most favorable outcomes and cost savings were reported from sites that had limited access to client tracking software and were challenged to develop a tracking system on their own. These sites reported the most significant time and cost savings. Project partners explored the possibility of hosting the Care Transitions Coaching Tool on the statewide web-based client tracking system and also commissioned an assessment and plan to convert the tool to a web-based platform. The current provider contract and scope of work did not allow for conversion to the web, but project partners will continue to explore funding and development possibilities for a web-based tool. Web delivery of the tool would likely promote more widespread adoption of the Care Transitions Coaching Tool.

HOW THEY DID IT?

Context of the Innovation: The Care Transitions Coaching Tool supports delivery of the Care Transitions Intervention®. It does not replace training or any other aspect of program content; it is simply a tool to track and report on program activities and survey responses (optional).

The Care Transitions Coaching Tool runs with Microsoft ACCESS 2007. Separate versions/datasets can be run by each person on the team or a single file stored on a secure shared folder can be accessed by several persons. It is not available in a web-application version at this time, although demand for web-based access would likely be high. Sites are responsible for storing and accessing the data according to local and federal policies and regulations. Transition coaches generally enter data about their coaching activities and any consumer responses to surveys into the tool after face-to-face interactions and during telephone interactions.

Planning and Development Process: The Care Transitions Coaching Tool was developed based on input from experienced coaches, supervisors, and evaluators. Project teams made additional requests for changes after adopting the tool. Changes were made in “batches” to prevent loss of existing data. Local site programmers also made additional local changes as needed to customize the tool to specific site protocols and preferences.

Resources Used and Skills Needed:

  • Staffing: No additional specialized staff is required for the adoption of the Care Transitions Coaching Tool. Although it is recommended that teams have access to persons familiar with Microsoft ACCESS who can trouble-shoot problems and make edits to the tool to fit local needs. Initial training on the Care Transitions Coaching Tool may or may not be necessary, depending on individual staff experience with the software. A User Guide with general information specific to the tool is available to help users get started, but it does not contain comprehensive Microsoft Access instructions.
  • Costs: Costs include a) Microsoft ACCESS software installed on all computers that will run the tool, b) shared storage space if required for local protocols, and c) occasional consultation and possible programming hours from an individual familiar with Microsoft ACCESS.

ADOPTION CONSIDERATIONS

Getting Started With This Innovation: The Care Transitions Coaching Tool is available for free to programs delivering the Care Transitions Intervention®. Details on the intervention and training to deliver the intervention are not tied to the tool and should be obtained prior to using the tool. All computers require Microsoft ACCESS 2007 to run Version 10 of the tool. It can be run in 2003 software if converted to that version. It is important to have at least one person on the team or available as a consultant who knows how to use Microsoft ACCESS.

Sustaining This Innovation: The Care Transitions Coaching Tool is easy to use, requires little maintenance, and it promotes time and cost savings for teams implementing the Care Transitions Intervention®.

Backup copies should be saved regularly when data are stored in the tool to prevent loss of data. Changes to the tool require at least basic knowledge of Microsoft ACCESS. Extracting and merging data from several copies of the tool is burdensome. When possible, all users should save data into the same copy of the tool so data are stored together. Shared network drives are ideal for this purpose. Secured/ encrypted external drives can also be used for this purpose or multiple users can use the same copy of the tool on the same computer if necessary.

The data collection, merging and analysis issues could be addressed with the implementation of a web application. Creating a web application for the tool would provide a more accessible way for multiple sites to track the care transitions intervention delivery. The opportunities for review of aggregate data from multiple sites would also be enhanced. In addition, this web application would promote increased adoption by allowing increased access to the tool from more locations.

Other Considerations and Lessons: It is important for coaches to continue to intervene with individual patients and caregivers as they were trained to. The Care Transitions Coaching Tool should only be used to document their activities and not to direct their coaching activities. The primary benefits of the tool exist in regular review and reporting processes where data is analyzed to determine more effective coaching activities and opportunities for assuring fidelity to the Care Transitions Intervention®.

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