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Role of Post-Acute Care in New Care Delivery Models

With new models for the delivery of health care, post-acute care provides — long-term care hospitals, skilled nursing  and rehabilitation facilities, and home health agencies — have an important role to play. They can help reduce hospital readmissions, improve care coordination and care setting transitions, and participate in the development of bundled payment approaches.

A new Trendwatch report from the American Hospital Association looks at the factors driving changes in post-acute care and highlights innovative examples of how leading post-acute care providers and health systems are adjusting and creating new business models to improve patient care.

A separate addendum report provides more background on Medicare spending by sectors within post-acute care and their patient characteristics. Medicare’s current fee-for-service system by post-acute care venue is also summarized.

Source: Role of post-acute care in new care delivery models. Trendwatch, American Hospital Association, Dec. 2015. http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf  Addendum: Background On Post-Acute Care. http://www.aha.org/research/reports/tw/15dec-tw-postacute-adden.pdf

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

Achieving Price Transparency for Consumers: a Hospital Toolkit

The American Hospital Association has released a new toolkit to help hospitals address price transparency. After discussing the what and why of price transparency, the toolkit recommends these action steps:

  1. Put yourself in the shoes of the consumer
  2. Train your staff
  3. Make information meaningful
  4. Know how your information compares to others — not just hospitals but other providers — in its accessibility and usefulness
  5. Tap your community for help

A self-assessment checklist is included for further help, followed by case examples from nine providers, sample web-based tools, and additional resources.

Source: Transparency for consumers: a hospital toolkit. American Hospital Association, July 2014. http://www.ahacommunityconnections.org/content/14transparencytoolkit.pdf

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

AHRQ Health Care Innovations Exchange

Looking for case studies on how to improve quality or reduce disparities in health care? The Health Care Innovations Exchange from the Agency for Healthcare Research and Quality is a good place to check.

AHRQ defines innovation as any new or altered product, service, process, system, policy, organization structure, or business model, but the innovation must be freely available, effective, truly innovative within its setting or target population, and focused on health care quality.  Technical, clinical, and educational innovations are generally excluded. The Agency invites submissions that receive an editorial review, with the innovations described in this general format:

Snapshot

  • Summary
  • Evidence rating
  • Developing organizations
  • Date first implemented

What they did

  • Problem addressed
  • Description of innovative activity
  • References/related articles
  • Contact the innovator
  • Innovator disclosures

Did it work?

  • Results
  • Evidence rating

How they did it

  • Context of the innovation
  • Planning and development context
  • Resources used and skills needed
  • Funding sources
  • Tools and other resources

Adoption considerations

  • Getting started with this innovation
  • Sustaining the innovation
  • Additional considerations and lessons
  • Use by other organizations

Those using the Exchange can browse or search by topics in these categories:

  • Disease or clinical category
  • Patient care process
  • Setting of care
  • Quality improvement goals and mechanisms
  • Patient population groups
  • Stage of care
  • Institute of Medicine (IOM) domains of quality
  • Organizational process
  • Quality tool topics
  • State

By registering on the site, users can sign up to receive alerts and updates, save innovations of interest, and share comments.

Sources:

AHRQ Health Care Innovations Exchange. Agency for Healthcare Research and Quality, accessed Aug. 26, 2013 at http://www.innovations.ahrq.gov/

AHRQ health care innovations exchange: combined inclusion criteria for health care service delivery innovations and health care policy innovations. Agency for Healthcare Research and Quality, accessed Aug. 26, 2013 at http://www.innovations.ahrq.gov/inclusion/combined.aspx

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

Adopting Electronic Health Records – Experiences of Leading Hospitals

The experiences of nine hospitals that recently implemented a comprehensive EHR system were analyzed to determine the success factors they had in common and the improvements in patient safety and efficiency realized. The hospitals included in the study were: 

  1. Carilion Roanoke Memorial Hospital [Roanoke VA]
  2. Doctor’s Hospital [Columbus OH]
  3. Geisinger Wyoming Valley Hospital [Wilkes-Barre PA]
  4. Gunderson Lutheran Medical Center [La Crosse WI]
  5. Metro Health Hospital [Wyoming MI]
  6. New York-Presbyterian Hospital [New York NY]
  7. Sentara Norfolk General Hospital [Norfolk VA]
  8. VA Central Iowa Health Care System [Des Moines IA]
  9. Yale-New Haven Hospital [New Haven CT]

Successful implementation depended on:  

  • Strong leadership that is both forceful and realistic
  • Full involvement of clinical staff in design and implementation
  • Mandatory staff training
  • Strict adherence to timeline and budget

Specific implementation challenges faced by the hospitals and their solutions are discussed.           

Source: Silow-Carroll S and others. Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. Commonwealth Fund, July 2012. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf

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

Eliminating Central Line Infections: Lessons Learned from High-Performing Hospitals

A new synthesis report from the Commonwealth Fund shares experiences and insights from four hospitals that successfully eliminated central line-associated bloodstream infections [CLABSI] from their intensive care units in 2009. A central line infection occurs when a central venous catheter is improperly inserted or maintained. According to the report, there were about 43,000 CLABSIs nationwide in 2009 with nearly 20% resulting in patient deaths.

Four case studies focus on lessons learned from these hospitals that eliminated CLABSI in their ICUs in 2009 and are working to extend their CLABSI prevention strategies to other units:

  • Bronson Methodist Hospital [Kalamazoo MI]
  • Englewood Hospital and Medical Center [Englewood NJ]
  • Presbyterian Intercommunity Hospital [Whittier CA]
  • Southern Ohio Medical Center [Portsmouth OH]

Success factors identified for eliminating the central line infections included:

  • Following evidence-based protocols to prevent CLABSI
  • Having a dedicated team to oversee the effort
  • Participating in national, regional or state collaboratives or initiatives
  • Monitoring infection rates closely and providing feedback to staff

Source: Silow-Carroll S and Edwards JN. Eliminating central line infections and spreading success at high-performing hospitals. Commonwealth Fund, Dec. 2, 2011. http://www.commonwealthfund.org/Publications/Case-Studies/2011/Dec/CLABSI-synthesis.aspx.

Individual case studies:

Silow-Carroll S and Lashbrook A. Bronson Methodist Hospital: Reducing central line bloodstream infections in critical care units and beyond. Commonwealth Fund, Dec. 2, 2011. http://www.commonwealthfund.org/Publications/Case-Studies/2011/Dec/Bronson-Methodist-Hospital.aspx 

Edwards JN and Silow-Carroll S. Englewood Hospital and Medical Center: Seven consecutive quarters without a central line–associated bloodstream infection. Commonwealth Fund, Dec. 2, 2011. http://www.commonwealthfund.org/Publications/Case-Studies/2011/Dec/Englewood-Hospital-and-Medical-Center.aspx

Edwards JN and Silow-Carroll S. Presbyterian Intercommunity Hospital: Five Years Without a Central Line–Associated Bloodstream Infection. Commonwealth Fund, Dec. 2, 2011. http://www.commonwealthfund.org/Publications/Case-Studies/2011/Dec/Presbyterian-Intercommunity-Hospital.aspx

Silow-Carroll S. Southern Ohio Medical Center: eliminating central line infections in the ICU.  Commonwealth Fund, Dec. 2, 2011. http://www.commonwealthfund.org/Publications/Case-Studies/2011/Dec/Southern-Ohio-Medical-Center.aspx

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

How do top-performing hospitals reduce readmissions?

A recent report from the Commonwealth Fund synthesizes the findings from studies of four hospitals with exceptionally low readmission rates:  McKay-Dee Hospital in Ogden, UT; Memorial Hermann Memorial City Medical Center in Houston, TX; Mercy Medical Center in Cedar Rapids, IA; and St. John’s Regional Health Center in Springfield, MO.

What do they have in common? First of all, their primary focus is not on reducing readmissions but achieving clinical excellence by investing in quality improvement strategies. Additionally, they identify and target patients at the highest risk for readmission and begin care management and discharge planning early to ensure a smooth transition. In some cases, new roles for nurses, pharmacists, hospitalists, and other care coordinators have been leveraged to manage patients’ needs.

For more information on best practices to reduce readmissions, see the full report at http://www.commonwealthfund.org/Content/Publications/Case-Studies/2011/Apr/Reducing-Hospital-Readmissions.aspx

Source:

Silow-Carroll, S., Edwards, J. N., and Lashbrook, A. Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals.  New York: The Commonwealth Fund, Apr. 2011.

Success Under Duress: Hospitals That Thrive with Challenging Payer Mixes

The Success Under Duress project looked at the strategies and practices associated with profitable financial status among California safety net hospitals, those hospitals with a high proportion of Medicaid patients,  a high rate of uncompensated care, and a low percentage of privately insured patients when compared with other hospitals. The project researchers identified 67 California hospitals with this challenging payer mix, and found 11 of them were performing well on at least half of standard financial performance indicators.

Five of these financially successful hospitals were selected for case studies:

  • Alameda County Medical Center [Oakland]
  • Fairchild Medical Center [Yreka]
  • Marian Medical Center [Santa Maria]
  • Providence Holy Cross Medical Center [Mission Hills]
  • Sierra View District Hospital [Porterville]

These key factors were found to be the primary contributors to their financial success, and each is discussed further in the report:

  1. Quality – strengthening the negotiating position with payers
  2. Strategic growth – increasing the volume of patient services
  3. Management discipline – intense monitoring and control over expenditures and efficiencies
  4. Culture – creating organizational values that support collaboration and accountability
  5. Relationships – establishing strong hospital-employee and hospital-physician relations

Sources:

Rundall T and others. Success under duress: how five hospitals thrive despite challenging payer mix. California HealthCare Foundation Issue Brief, Sept. 2010. http://www.chcf.org/~/media/Files/PDF/S/PDF%20SuccessUnderDuressHowFiveHospitalsThriveDespiteChallengingPayerMix.pdf

Rundall T and others. Success under duress: how five hospitals thrive despite challenging payer mix. A project of the University of California, Berkeley, funded by California HealthCare Foundation, final report, Sept. 2010. http://www.centerforhealthcaremanagement.com/yahoo_site_admin/assets/docs/SUD_Final_Report_and_Cases_V6.270114446.pdf