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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

READMISSIONS: What is a transitional care bundle?

Kaiser Permanente Northwest (Portland, Ore.) developed a transitional care bundle in 2009 intended to assist patients on discharge from hospital to home.  The initial results of implementation of this approach are reported in this study.  Hospital inpatients are assigned a risk level – high, medium, or low – and then receive different level of support services.  The services include:

  • Telephone hotline number
  • Same-day standardized discharge summaries and discharge instructions
  • Post-hospital follow-up – 5 days for high risk and longer for lower risk patients
  • Medication reconciliation

In the 269-bed hospital that was studied, about half of all patients discharged from hospital to home were judged to be high risk.  In the 5 years studied, the readmission rate was cut from 12.1 percent to 10.6 percent.

Source: Rice, Y.B., and others. (2016, Feb.). Tackling 30-day, all-cause readmissions with a patient-centered transitional care bundle. Population Health Management, 19(1), 56-62.  Click here: http://online.liebertpub.com/doi/pdf/10.1089/pop.2014.0163

Related news item: Erich, J. (2015, July 1). Kaiser Permanente’s plan to prevent readmissions. IH Executive. Click here: http://www.ihexecutive.com/patient-care/clinical-pathways/article/12076292/kaiser-permanentes-plan-to-prevent-readmissions  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SATISFACTION: Academic medical center improves the patient experience

This is a case study of University of Utah Health Care, a four-hospital system that was created in 2004 by bringing together the School of Medicine and the University Hospitals and Clinics.  Radically different cultures hampered the ability of the organization to achieve top patient satisfaction scores until launch of an initiative in 2008.  Working on aligning culture was one of the first tasks of the Exceptional Patient Experience (EPE) initiative.  Among the other EPE activities were revision of the mission, vision, and values statements; value-based hiring, retention, and promotion; and, sharing physician-specific patient feedback data.  Besides the improvement in patient satisfaction scores, the system has seen a big drop in malpractice premium rates and an increase in employee satisfaction.

Source: Lee, V.S., Miller, T., Daniels, C., and others. (2016, Mar.). Creating the exceptional patient experience in one academic health system. Academic Medicine. 91(3), 338-344.  Click here for publisher’s website: http://journals.lww.com/academicmedicine/Fulltext/2016/03000/Creating_the_Exceptional_Patient_Experience_in_One.25.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NEEDLESTICK: What is the sharps injury rate in hospitals?

FINDINGS: 21.37 percutaneous injuries per 100 average daily census from EPINet – 2013

These data are from the International Safety Center, in a survey report called the Exposure Prevention Information Network, or EPINet.  This reporting system was established in 1992 and is distributed to over 1,500 U.S. hospitals.  However, the number of hospitals reporting is much smaller – about 25 U.S. hospitals, per telephone call to the ISC, 434.962.3470 (on 2/24/16).

Source: International Safety Center (no date, 2014?). EPINet report for needlestick and sharp object injuries.  Click here: https://internationalsafetycenter.org/wp-content/uploads/2015/08/Official-2013-NeedleSummary.pdf

FINDINGS: 16.5 sharps injuries per 100 licensed hospital beds in MASSACHUSETTS – 2012

The State of Massachusetts requires hospitals to report their annual sharps injury rates.  Here are the most current data – for 2012:

 

Type of Hospital Rate of Sharps Injuries per 100 Licensed Beds
Small (less than 100 beds) 14.0
Medium (101-300 beds) 10.3
Large (greater than 300 beds) 26.6
All hospitals 16.5
Teaching 27.7
Non-teaching   9.7

Source: Massachusetts Department of Public Health, Occupational Health Surveillance Program. (2014, Aug.). Sharps injuries among hospital workers in Massachusetts: Findings from the Massachusetts Sharps Injury Surveillance System, 2012.  Click here: http://www.mass.gov/eohhs/docs/dph/occupational-health/injuries/injuries-hospital-2012.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

Patient and Family Engagement Resource Compendium

A new resource compendium links users to key resources on patient and family engagement. The resources, each briefly described, are grouped into these categories:

  • Leadership
  • Organizational assessments
  • Patient and family advisory council/committee: resources for hospitals
  • Partnering to improve the quality of care
  • Engaging patients and families during the hospital stay
  • Health literacy: resources for providers
  • Health literacy: resources to help patients communicate with providers and manage medications
  • Health literacy: resources to help patients prevent adverse events in the hospital
  • Shared decision making
  • Engaging to reduce disparities

The compendium also explains how the resources can help in getting started with a new program or initiative, and it ends with a general bibliography of additional article references.

Patient and family engagement resource compendium. Health Research & Education Trust, Dec. 2015. http://www.hret-hen.org/topics/pfe/20160104-PFEcompendium.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ADVANCE DIRECTIVES: Making choices for the end of life

Over one-quarter of Medicare payments are made for patients in the last year of their lives.  There can be a disconnect between what patients want in terms of medical care and treatment at the end of their lives and what actually happens once 911 is called.  There have been attempts to address this disconnect through development of advance directive documents (which can go missing over time or be misinterpreted).

Here are some resources to help in end of life planning.

Gundersen Health System has implemented an advance directive program  that has resulted in an almost perfect match between a dying patient’s wishes and treatment decisions.  Also, the cost of care during the last two years of life, as well as the intensity of hospital care during this period, is lower than the national average.

Source: Fifer, J.J. (2015, Nov.). Time to break the last taboo. HFM. Healthcare Financial Management, 69(11), 28. Retrieved from http://www.hfma.org/Content.aspx?id=42943

Should you get your annual physical?

These two companion articles are a point-counterpoint discussion of the value of continuing the practice of annual physicals, or periodic health exams, for adults.  Annual physicals are the most common reason that Americans visit doctors and cost an estimated $10 billion or more each year.  Drs. Mehrotra and Prochazka argue that there is value in a regular “relationship visit” or a “primary care maintenance visit,” but that these need not necessarily be every year.  They go so far as to argue that payers should “no longer reimburse for annual physicals or use receipt of physicals as a measure of health care quality.”  Dr. Goroll argues that the annual physical should be improved by making it of longer duration and more of a team effort – with the screening, data collection, and data recording assigned to non-physician staff.  He agrees that the interval might be longer than a year for low-risk patients.

Sources:

Mehrotra, A., and Prochazka, A. (2015, Oct. 15). Improving value in health care: Against the annual physical. The New England Journal of Medicine, 373(16), 1485-1487. http://www.nejm.org/doi/pdf/10.1056/NEJMp1507485

Goroll, A.H. (2015, Oct. 15). Toward trusting therapeutic relationships: In favor of the annual physical. The New England Journal of Medicine, 373(16), 1487-1489.  http://www.nejm.org/doi/pdf/10.1056/NEJMp1508270  Posted by AHA Resource Center (312) 422-2003, rc@aha.org