Quality: Using Available Data

Janice Simmons, for HealthLeaders Magazine , July 10, 2009
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Avoiding unnecessary hospitalizations could save about $412 for each person who received an intervention, Jack said. "There's not too many things that improve care and save money. This is one." Interested organizations can download a free toolkit, with an after-hospital care plan and a training manual, at the Project RED site.

A free toolkit also is available at the Society for Hospital Medicine's "Better Outcomes for Older Adults Through Safe Transitions" (BOOST) program (see www.hospitalmedicine.org). The program is fairly new: Six hospitals entered into a pilot mentoring program last fall, and 22 more entered this spring, according to Tina Budnitz, the program's director.

One of the hospitals participating is the 697-licensed-bed Hospital at the University of Pennsylvania, Philadelphia, which implemented the BOOST program on one floor serving a general population of patients. But rather than just target older individuals, "we decided to roll it out on every patient that was admitted," said Emmanuel King, MD, director of clinical operations for the section of hospital medicine and lead physician on the floor.

The hospital functions partially as a safety net hospital so we "have a significant number of patients who are underserved from the surrounding urban community," King said.

The hospital used the "7P" checklist, found in the BOOST toolbox, which simplifies the major factors for readmission to the hospital, King said. It addresses seven risk factors tied to suggested intervention for the following categories: problem medications, principal diagnosis, depression, polypharmacy, poor health literacy, patient support, and prior hospitalization. Risk factors are tied to suggested interventions.

"We've been given leeway to tailor it to whatever resources we have," King added. For instance, since a pharmacist makes rounds, an intervention was added where patients may get a special packet of information with pictures of a medication, in addition to names and doses to increase compliance.

Not all of the patients truly need all of the interventions "but you end up screening in more people than you would have before," said King. The result has been a drop in readmissions—from a high of 15% (before the hospital entered the pilot project in the fall of 2008) to 5% in February of this year.

Some conditions are associated with higher readmission rates than average, such as heart failure: Medicare data has shown that the 30-day readmission rate for heart failure patients is about 27%. Keeping this in mind, 540-licensed-bed St. Luke's Hospital in Cedar Rapids, IA, created its own program in 2006 called Transitions Home. The result has been a drop from 20% readmissions in the early part of the decade to 14% with the advent of the program to 4% currently, said Peg Bradke, RN, MA, St. Luke's Heart Care Services director.

The problem that the hospital had observed was that when patients had been discharged from the hospital, many of them did not qualify for home care visits. To address this, the hospital teamed up with the local Visiting Nurses Association in which patients would get a complimentary visit within 24 to 48 hours after discharge and then make sure they get into a physician's office within three to five days. And then, within seven to 10 days, an advanced practice nurse for heart failure follows up with a phone call to the patient.

"Right now we are losing some revenue. But it's the right thing to do for the patient," Bradke said. "Our mission is to give the care we would like our loved ones to receive."

Janice Simmons is senior quality editor for HealthLeaders Media. She maybe contacted at jsimmons@healthleadersmedia.com.

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