Primary Care Finds a (Medical) Home

Joe Cantlupe, for HealthLeaders Media , June 13, 2013
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Ogden says Cornerstone also uses a standardized method developed by Press Ganey to assess patient experience, with the intent of boosting patient satisfaction scores. It established a PEAK (Patient Expectations Are Key) team that continually reviews patient satisfaction scores and aims for improvement, he says.

The PEAK team includes representatives from clinical operations, medical staff, nursing, and "focuses on enhancing the patient experience," Ogden says. As an example, nurse navigators made repeated phone calls to patients to ensure they were taking their medications and keeping their appointments. In one instance, a nurse navigator's persistent questioning of a breast cancer patient who said she wasn't hungry revealed that the patient hadn't eaten for several days. As a result, the nurse immediately assembled a team to collect food to give her.

Physician champion Yates Lennon, MD, heads the PEAK team. Each month, written communications are sent to staff to provide what they term "wow stories, [patient satisfaction] score updates, and constant reminders about the goals," according to Ogden.

Over the past three years, the PEAK team has worked with staff to oversee a continual improvement in patient satisfaction scores. Three years ago, Cornerstone was in the 76th percentile of patient satisfaction, and it reached 90% in 2013, Ogden says. Cornerstone officials saw the need for change after several failed attempts to boost patient satisfaction scores.

Ultimately, to obtain sufficient patient satisfaction, it's important to have the patients engaged, Ogden says. "Folks aren't used to being reached and touched by a healthcare delivery system," he says. "It's engagement when the healthcare navigator helps patients achieve their healthcare goals."

Success key No. 4: Bridging community gaps

In western North Carolina, air quality issues are producing some of the highest rates of asthma in the state, particularly among children, says Susan Mims, MD, MPH, vice president and medical director of the 135-staffed-bed Mission Children's Hospital in Asheville, N.C.

Through Mission Children's Hospital Regional Asthma Disease Management Program, the hospital uses its regional network to provide intensive case management by respiratory therapists to children suffering from asthma. As a result, the hospital has made inroads in bridging care in the community—thereby reducing emergency department use and all-too-frequent hospitalizations among asthma patients, Mims says.

Mission began its program after evaluating hospital admissions and school absences, and calculated the cost estimate for ED visits.

The asthma program uses a multifaceted educational approach to help families understand the causes, signs, and symptoms of asthma attacks and the proper use of medications, and connects families with community resources that can help.

The hospital's program focuses on children who may not have received intervention on a regular basis, Mims says. The children targeted for these interventional services are those with moderate and severe asthma, and they receive clinical services in a doctor's office, at home, or at school or daycare.

 "This work is vitally important, because we target the highest–risk children whose asthma has not been controlled," Mims says.

RADMP activities have contributed to the reduction of asthma-related emergency visits by 85% and hospitalizations by 95%, equaling a total savings of more than $800,000. The estimated cost savings from the ED visits alone was $142,000, and for hospitalizations, it was $687,477, Mims says.

With coordination under the medical home, ED utilization and hospitalizations declined dramatically, Mims says. Before the program was launched, there were 158 visits reported in 2011; postintervention, there were only nine in one cohort of patients, she says. As for hospitalizations, there were 60 pre-intervention and only three after the program started.

To accomplish these clinical and financial results, the hospital coordinated with Community Care of North Carolina, a Medicaid-run program, and area pediatric primary care practices. "There was a big focus to make sure that kids were getting care addressed in primary care offices and to make sure their asthma was being addressed, and that they would not end up in the ED or admitted to the hospital," Mims says.

Primary care medical homes are involved in ensuring that children continue to receive care for asthma—outside the hospitals. Respiratory therapists coordinate with the program to "visit the schools, the child care centers, meet parents, and talk with families," Mims says. "We're trying to prevent asthma attacks by educating and changing the environment so the disease can be managed more effectively."

Reprint HLR0613-7

This article appears in the June issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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