VNAA Engaging in Quality
Reducing Hospitalizations
Tuesday, December 18, 2012
by: VNAA Quality and Education Team

Section: Quality and Educational Programming


The VNAA’s Engaging in Quality Virtual Learning Collaborative (VLC) is committed to improving care for all VNAA members and other nonprofit home health agencies across the country. This Collaborative is based on lessons learned from proven health care initiatives demonstrating reductions in hospitalizations as well as best practices from home health and community-based practices. This program is designed to increase collaboration among and within each participating organization. Participating home health agencies will receive expert training and consultation on capacity building, Institute for Healthcare Improvement (IHI) Plan, Do, Study, Act (PDSA) training as well as current best practices to reduce hospitalizations. The success of each organization will be directly related to the engagement of the quality improvement team and the executive team’s sponsorship and advocacy.

Overall Learning Strategy


To help home health agencies meet and/or improve patient-centered care and reduce hospitalizations/re-hospitalizations: 
  1. Engage health care providers at all levels of the home health organization to improve the quality and safety of patient care;
  2. Identify key skills and knowledge needed for capacity building to develop and offer series that will provide you with the “right skills” to initiate and sustain changes in your organization; and
  3. Develop and encourage the spread of effective and replicable quality improvement strategies, models and resources within the organization and home health communities.

Target Audience

The Engaging in Quality Collaborative targets all of our nonprofit home health agencies. Through their participation, home health agencies will:
  • Position their agency to lower their hospitalization rates, enhance their relationship with their hospital partners and help hospitals avoid a 1% reduction in the Medicare reimbursement;
  • Be better positioned to meet regulatory and accreditation standards;
  • Demonstrate their commitment to achieving high-quality, evidence-based practice;
  • Participate and collaborate with other home health agencies through peer-to-peer and shared learning activities;
  • Access an inventory of best practices, strategies and tools;
  • Receive technical assistance from national experts in home health agency quality improvement; and
  • Gain national visibility by participating in efforts to improve the quality of home health care.


Improvement areas for VNAA Engaging in Quality Collaborative

Home health agencies that join the Engaging in Quality Collaborative will become part an organic network of organizations that learn and share Quality Improvement (QI) tools, strategies and lessons with each other. Every participating home health agency will have the opportunity to participate in QI work that is customized for their organization, and will be offered the flexibility of selecting the goals and strategies that are most appropriate for their organization at this time.

Engaging in Quality Collaborative Design Features

The Engaging in Quality Collaborative rollout will begin late October with recruitment of agencies. Recruitment will be completed by December, 2012, with the first online training taking place in January 2013. The Engaging in Quality Collaborative will run for 15 months starting in January 2013 and ending in March 2014. As part of the Collaborative there will be an in-person meeting at the VNAA Annual Meeting in April 2013, for those able to participate. This meeting will offer an educational program from experts in best practices as well as offer an opportunity to share lessons learned, successful strategies and data from participation in the Engaging in Quality Collaborative.


Recruitment will begin by November 2012 utilizing the VNAA marketing materials, the VNAA listserv, weekly Member Update e-newsletters (MUs), Webinars and other lists of nonprofit home health and hospice agencies. The primary marketing material will consist of the business case paper as well as information on the responsibilities, timeline, summation of contents on training and materials, CEO engagement materials and description of toolkits. These will be made available to potential participants. VNAA staff will facilitate marketing, recruitment, and engagement of the participants. VNAA staff will also track enrollment, provide regular updates, assistance and encouragement to potential participants. The VNAA staff will conduct conference calls and Webinars to describe the value and importance of this program.


Home health agencies will enroll with the VNAA through a centralized online process. The CEOs from all participating agencies will also be required to sign a participation commitment agreeing to actively pursue goals for reducing hospitalizations.

Change Package

All enrolled home health agency teams will be trained on the collection of data utilizing tools from the VNAA. Additional training will involve Webinars on leadership and organizational readiness; facilitation and team work; data use and management and PDSA. Change package materials will include the published STAAR report (2012) from IHI as well as other best practices, including seven approaches that represent the best practices in home care today. These include: medication reconciliation, educating patients on signs and symptoms, follow-up appointment with MD in 7-14 days, front loading , motivational interviewing and coaching, identifying high risk patients and teach back and health literacy. As part of the agreement of participation, home health agencies must agree to the requirements of monthly submission of data and updates on their goals.

Since quality improvement methods, such as rapid cycle of PDSA, are the foundation to implement change and to meet PDSA specified goals, the VNAA staff will provide access to interventions, strategies, approaches, tools and actions to participating agencies.
The change packages will expand based on the work of additional home health agencies participating in the Engaging in Quality Collaborative. The VNAA will work with the participants to spread these resources and approaches for their organizations and to other home health agencies.

Learning Strategies

The VNAA Engaging in Quality Collaborative will utilize a variety of methods to spread tools and resources, as well as provide technical assistance. Technical assistance will be focused on distance learning. The VNAA staff will provide this assistance through:
  • Quality Forums/Monthly Webinars designed to gain expert knowledge, share information among home health agencies and plan action steps for home health agency teams;
  • Facilitation of peer-to-peer learning utilizing targeted conference calls;
  • Consultation with QI leaders and other experts;
  • Online resources and toolkits to bolster team learning;
  • Engaging in Quality Collaborative Website resources;
  • Data analysis and feedback; and
  • Assessment of progress reports and dissemination of best practices.
Technical assistance will be focused on the principles of distance learning. There will be no site visit or general meeting requirements made by the VNAA staff.

Performance Measurement

Each organization will use relevant performance measures and goals based on the best practices provided by the VNAA staff in conjunction with the Quality Task Force. The VNAA staff will provide a password-protected data collection Website through which each agency will be able to submit data on the required set of performance measures. Periodic analysis and feedback of key quality indicators will be provided to participating home health agencies.

Goals and Performance Measures

The goals for the Reducing Hospitalizations are:
  1. Reduce hospitalization rates by 5% from baseline to March 2014 or to a target of 20% during a home heath episode of care.

Home health agency learning activities

Home health agencies will participate in a variety of structured activities designed to ensure the successful achievement of the organization’s Quality Plan and improvement area goals. These activities provide training for the organizations as well as opportunities for sharing and learning.


  • Launch Webinars: Each improvement area will hold a 2-hour introductory webinar to explain and clarify roles and responsibilities of the home health agency and participants, discuss goals and quality improvement methods for achieving them and introduce the toolkits as a resource for useful ideas and proven strategies. In-depth information on performance measures and collecting and reporting data will be discussed.


  • All home health agencies will be trained on the collection method for each specific plan chosen to address the goals of reducing hospitalization. Some of the data will be collected and returned to each site through the VNSNY research team on a monthly basis as well as to VNAA staff.
  • Key project leaders and designated personnel will be required to attend 10 to 11 one hour webinars training on capacity building, IHI PDSA model for performance improvement as well as best-practices. The VNAA staff will provide the faculty with technical support for these webinars. Home health agencies will be asked to complete an initial assessment of their agency’s current practice related to key best practices, as identified by the Quality Task Force and VNAA staff. The VNAA staff will assist agencies in identifying best practices and strategies related to their goals. Agencies not participating in these seminars will be contacted to participate and to view recorded sessions in order to be prepared to launch their program in the Collaborative.
  • Connecting with VNAA office staff: Home health agencies will be asked to periodically report to the VNAA staff on their progress, successes and lessons learned. Quality Forums and email newsletters will reinforce to home health agencies the importance of communication and updates.
  • The VNAA staff will update the Project Leader email on at least a quarterly basis to review receipt of submissions data, improvement plans and progress reports. Topics to be covered will include (but are not limited to): 
  • Notable successes or achievements of home health agency teams;
  • Observations; and
  • Home health agency non-participation (i.e., home health agencies that have failed to submit data or attend monthly Quality Forum) for consecutive months; and have not responded to contact by the VNAA staff.
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