Innovations and Efficiencies in Home-Based Care: HCCI Solutions Suite for NPHI Members-IDT Meeting Guide

IDT Meeting Guide

Pdf Summary

The document provides guidelines for developing and implementing Interdisciplinary Team (IDT) meetings in house call programs to improve clinical care, quality outcomes, and team communication. These meetings cover key metrics, hospitalizations, case management, announcements, process waste identification, recognition, and example outcome metrics for home-based primary and palliative care.<br /><br />Key agenda items for IDT meetings include:<br /><br />1. **Key Metrics**: Monitoring success through clinical quality metrics and outcome tracking.<br />2. **Hospitalizations**: Assigning a team member to track and analyze patient hospital admissions and brainstorming interventions to prevent future occurrences.<br />3. **Case Management**: Discussing complex patient cases to plan and allocate necessary resources.<br />4. **Announcements and Updates**: Sharing essential updates affecting the team, which may include logistical or operational information.<br />5. **Waste Identification**: Identifying process inefficiencies for improvement through methodologies like Lean Six Sigma.<br />6. **Recognition**: Providing positive feedback and encouraging team recognition through informal submissions such as “Thank You” notes.<br /><br />Example metrics for monitoring outcomes include:<br />- Deaths at home versus in healthcare facilities.<br />- Referral rates, visit frequencies, and hospitalization rates.<br />- ICU and hospitalization data before death, yearly patient census, and wait times for first visits and transitional care management.<br /><br />Clinical quality metrics referenced include:<br />- Follow-up contact and medication reconciliation within 48 hours post-hospitalization.<br />- Annual documentation of patient preferences and monitoring all-cause hospital readmissions.<br /><br />The document also lists valuable resources and guides for effective teamwork, including principles of interdisciplinary teamwork, and process improvement methodologies. <br /><br />Additionally, the Home Centered Care Institute (HCCI) offers a variety of resources such as webinars, tools, tip sheets, virtual office hours, and a helpline to support home-based primary care providers and staff.<br /><br />The purpose of this guidance is to enhance the effectiveness of home call programs by leveraging structured, data-driven IDT meetings to improve patient outcomes and team dynamics.

Keywords

Interdisciplinary Team

IDT meetings

home call programs

clinical care

quality outcomes

team communication

process improvement

home-based primary care

palliative care

Home Centered Care Institute