Lawsuits Don’t Lead to Better Nursing Home Care - New York Times

By PAULA SPAN


We tend to think of a lawsuit as a kind of slingshot allowing the little guy to take on a daunting Goliath — a large nursing home chain, say. If you can’t persuade a facility to provide proper care, if your elderly relative has suffered unnecessarily as a result, then you can sue.

By doing so, you not only force the responsible parties to make amends for negligence or other errors, the logic goes — you also compel them to shape up, and thus provide better care for everyone.

It’s disturbing, therefore, to learn from a recent analysis in The New England Journal of Medicine that this notion doesn’t really hold. If lawsuits were a quality-control measure, then lousy nursing homes would be sued far more often than good ones. Providing excellent care would prevent litigation.
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Participatory Action Research for Culture Change

by JOHN DAVY

The culture change movement brought a much-needed emphasis on the dignity and humanity of those receiving long-term care. Research has identified many outcomes of culture change—reduction in over-medication, more home-like environments in LTC, improved social life for residents, and many other targeted benefits. However, as an article in the most recent Gerontologist notes, “little evidence suggests that elders them­selves have participated in the identification of areas in need of improvement within their LTC communities and in the development of culture change initiatives.” (Shura et al 2011). This article presents a study that involved older adult residents directly as experts and participants in implementing culture change in LTC.
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Geriatric Knowledge among Emergency Nurses | Aging In Action

by JOHN DAVY on APRIL 8, 2011

Adults age 65 and older make up at least 15% of emergency department visits, and have longer lengths of emergency department stay, as well as poorer post-discharge outcomes, than the general population. At the same time, most nursing baccalaureate programs do not require coursework in geriatric care. Does this imply a gap between training and practice, or are emergency nurses equipped with the knowledge to work with older adults? The Journal of Emergency Nursing published an article that surveyed nurses at one large California hospital (Roethler et al 2011) on geriatric knowledge and self-perception of nurse ability to work with older adults, which suggests that there may in fact be a knowledge gap.

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St. John’s Regional Health Center: Following Heart Failure Patients After Discharge Avoids Readmissions - The Commonwealth Fund

Authors: 
Aimee Lashbrook, J.D., M.H.S.A., and 
Jennifer N. Edwards, Dr.P.H.


Contact: 
Aimee Lashbrook, J.D., M.H.S.A., 
Health Management Associates,
alashbrook@healthmanagement.com


Editor: 
Martha Hostetter

Downloads

• Case Study (615K PDF)

Overview

St. John’s Regional Health Center (St. John's) has very low readmission rates among patients with heart attacks, heart failure, and pneumonia—the three conditions for which hospitals report readmission rates to the Centers for Medicare and Medicaid Services (CMS). Its rates are better than the top 10 percent of hospitals reporting (Exhibit 1).

St. John's, like other hospitals profiled in this case study series, did not set out deliberately to reduce readmission rates. Rather, the hospital has had a longterm commitment to establishing and adhering to care standards to deliver optimal care. Staff follow evidence-based practices, educate patients about their conditions during their stay and after discharge, provide coordinated care, and manage chronic diseases by working with providers in the hospital and community.

In addition, St. John's low readmission rates for heart attack and heart failure patients may be attributed to the close attention it pays to patients after discharge and its engagement of the community's primary care physicians. Further, being part of a system and working in partnership with its health plan have influenced how the hospital approaches care coordination and cost-effective care.

This case study focuses on St. John's strategies and efforts to improve heart attack and heart failure care and reduce related readmissions.

Patient-focused interventions after discharge

• telephone calls to all heart failure patients to answer questions and remind them about the importance of having a follow-up visit with their personal physician;
• referrals to an outpatient cardiac rehabilitation program;
• use of an interactive voice response telemonitoring program for heart failure patients;
• 24-hour nurse triage help line to provide after-hours support;
• medication assistance program for patients with limited resources; and
• 24- to 48-hour follow-up by a St. John’s Health Plans care manager (for health plan members) to review discharge instructions, ensure patients have appointments with their personal physicians, check medications, and remove any barriers to following treatment plans.

Interventions focused on community providers

• telephone and electronic notification to patients’ personal physicians about patients' hospitalization and need for follow-up visits within one week;
• "call in, get in" standard of care, in which personal physicians make heart failure patients a priority; and
• an electronic heart failure registry to track such patients' care over time.

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This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

Citation

A. Lashbrook and J. N. Edwards, St. John’s Regional Health Center: Following Heart Failure Patients After Discharge Avoids Readmissions, The Commonwealth Fund, April 2011.

Launching Accountable Care Organizations — The Proposed Rule for the Medicare Shared Savings Program | Health Policy and Reform

by Donald M. Berwick, M.D., M.P.P in NEJM

A common criticism of U.S. health care is the fragmented nature of its payment and delivery systems. Because in many settings no single group of participants — physicians, hospitals, public or private payers, or employers — takes full responsibility for guiding the health of a patient or community, care is distributed across many sites, and integration among them may be deficient. Fragmentation leads to waste and duplication — and unnecessarily high costs.

Section 3022 of the Affordable Care Act (ACA) establishes the Medicare Shared Savings Program for accountable care organizations (ACOs) as a potential solution.¹ The creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the ACA. Its purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Under the law, an ACO will assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to it on the basis of their patterns of use of primary care. If an ACO succeeds in both delivering high-quality care and reducing the cost of that care to a level below what would otherwise have been expected, it will share in the Medicare savings it achieves.

On March 31, 2011, the Department of Health and Human Services took a major step toward establishing ACOs by issuing a notice of proposed rule-making that will define how physicians, hospitals, and other key constituents can adopt this new organizational form. The issuing of the proposed rule follows months of obtaining informal and formal input from throughout the health care delivery system, but at this point the rule is only a proposal. The Centers for Medicare and Medicaid Services (CMS) will carefully review the comments we receive in response to the proposed rule before issuing a final rule later this year.

A critical foundation of the proposed rule is its unwavering focus on patients. We envision that successful ACOs will honor individual preferences and will engage patients in shared decision making about diagnostic and therapeutic options. Information management — making sure patients and all health care providers have the right information at the point of care — will be a core competency of ACOs. Held to rigorous quality standards (see table), ACOs will be expected to be proactive in their orientation and to regularly reach out to patients to help them meet their needs for preventive and chronic health care. Patients who seek care at their ACO will know that their physicians are part of that ACO, but as beneficiaries of fee-for-service Medicare, they will continue to be free to seek care from any Medicare provider they wish. They will not be locked into seeing only particular health care providers.
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What Is Nursing Home Quality and How Is It Measured? - The Commonwealth Fund

Authors: Nicholas G. Castle Ph.D., M.H.A., A.G.S.F., and Jamie C. Ferguson, M.H.A.

Journal: The Gerontologist, August 2010 5(4):426–42

Contact: Nicholas G. Castle, Professor, Graduate School of Public Health, University of Pittsburgh, castlen@pitt.edu

Summary Writers: Jennifer Dunham

The Issue

Numerous indicators are used to assess the quality of nursing home care, and there are many initiatives focused on quality improvement in nursing facilities. Questions remain, however, about the accuracy and effectiveness of these indicators and initiatives. Meanwhile, quality problems remain common.

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What the Study Found

The authors reviewed a range of quality indicators and improvement initiatives, including those used in the Facility Quality Indicators Profile Report, the federal Nursing Home Compare Web site, the Advancing Excellence in America’s Nursing Homes campaign, and deficiency citations issued as part of the Medicare and Medicaid certification process. Their analysis shows that all employ a mixture of structural, process, and outcome measures, "each of which has noted advantages and disadvantages."

Looking ahead, the health care reform law will require nursing homes to disclose ownership and financial information, as well as quality data on a Web site. Additional steps recommended by the authors include integrating nursing homes with the larger system of long-term care, enhancing current quality improvement initiatives, and upgrading the nursing home certification process.

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Conclusions

Improvements in nursing home quality have "likely occurred," the authors conclude, but more improvements are still needed.

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My Therapy

by Elena Portacolone

There is one life, live it to the fullest. James Pye, a 78-year old lanky man, hands me a visiting card with this motto at the end of my visit. An authority in African American history, last January he traveled for five entire days to Washington DC “to witness the inauguration of the President. That was great. I went there; I was there on crutches [he laughs]. And I was cramped up on a bus.”

His elongate face has a scar below the left temple, “It was an accident, trying to save somebody.” His brown darting eyes often make contact with mine; his full lips sometimes open to a boyish smile. A veteran, James is proud of his rigorous work ethic: “I have been in the military, working, and just teaching my kids to work. You didn’t sit down and do nothing.” Familiar with different political systems, James is well aware of the inequalities of the American one:

We have the highest living conditions in the world, but we’ve also the lowest. […] There’s a whole race of people that they kidnapped and brought over on the ship. […] And now, 400 years later, we’re in the same boat. We’re not in slavery, we’re not under the gun per se, but we’re not economical.

His struggle to get affordable housing hints to the hurdles to improve one’s living conditions. As tenant of an apartment in a Victorian building, James is afraid to be evicted once the 90-year landlady dies. At the same time, he has been waiting for nearly 30 years for an adequate public housing apartment in a safe environment. He says,

There was a lady, she was a lawyer. She said, “I can’t believe that you’ve been turned down that many times.”[…] She just stumbled into my case.

James searches in vain his apartment for a paper showing his eternal stand-by status. He walks through narrow paths carved between boxes, open suitcases, books, bags, and half-inflated party balloons, the lash of the oxygen cannula trailing behind his legs. Superimposed upon the fight for housing is his battle with cancer. A survivor of five heart operations, two back surgeries, and two low bowel surgeries, he explains that he contracted lung cancer “breathing asbestos trapped in the wall” of his ship during the Korean and Vietnams Wars. Where does James get all his strength? He says,

I recommend people, even if they are sick, take a walk or breathe some fresh air, or just get out and see something. Get out. Get out of your problems, your worries, and your situation. At some point, you know, God will help. That’s my therapy.

One of six stories on living alone in San Francisco published in Elena Portacolone’s monthly column in the newsletter of Planning for Elders -September 2010 – February 2011

National Quality Strategy Will Promote Better Health, Quality Care for Americans

Image via WikipediaCreated under the Affordable Care Act, first-ever strategy will guide local, state and national efforts to improve quality of care The U.S. Department of Health and Human Services (HHS) today released the National Strategy for Quality Improvement in Health Care (National Quality Strategy).

The strategy was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States.

"The Affordable Care Act sets America on a path toward a higher quality health care system so we stop doing things that don't work for patients and start doing more of the things that do work," said HHS Secretary Kathleen Sebelius. "American hospitals, doctors, nurses and other health care providers are among the best in the world. With this ground-breaking strategy, we are working with local communities and health care providers to help patients and improve the health of all Americans."

The National Quality Strategy will promote quality health care that is focused on the needs of patients, families, and communities. At the same time, the strategy is designed to move the system to work better for doctors and other health care providers - reducing their administrative burdens and helping them collaborate to improve care. The strategy presents three aims for the health care system:

. Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

. Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.

. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

To help achieve these aims, the strategy also establishes six priorities, to help focus efforts by public and private partners. Those priorities are:

. Making care safer by reducing harm caused in the delivery of care.

. Ensuring that each person and family are engaged as partners in their care.

. Promoting effective communication and coordination of care.

. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

. Working with communities to promote wide use of best practices to enable healthy living.

. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

The strategy was developed both through evidence-based results of the latest research and a collaborative transparent process that included input from a wide range of stakeholders across the health care system, including federal and state agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers. This process of engagement will continue in 2011 and beyond.

The National Quality Strategy is designed to be an evolving guide for the nation as we continue to move forward with efforts to measure and improve health and health care quality. HHS will continue to work with stakeholders to create specific quantitative goals and measures for each of these priorities. In addition, as different communities have different needs and assets, the strategy and HHS will empower them to take different paths to achieving these goals.

The National Quality Strategy is just one piece of a broader effort by the Obama Administration to improve the quality of health care, and will serve as a tool to better coordinate quality initiatives between public and private partners. For example, the Affordable Care Act established a new Center for Medicare and Medicaid Innovation that will test innovative care and service delivery models. These new models are being tested to determine if they will improve the quality of care and reduce program expenditures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Read the report at www.HealthCare.gov/center/reports.

For more information about the National Quality Strategy, visit www.ahrq.gov/workingforquality/.

Success Factors in Five High-Quality, Low-Cost Health Plans - The Commonwealth Fund

Authors: Robert A. Berenson, M.D., and Teresa A. Coughlin, M.P.H.
Contact: Robert A. Berenson, M.D., The Urban Institute, rberenson@urban.org
Editor: Deborah Lorber

Downloads

• Full Report (922K PDF)

Overview

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance. Plan leaders identified several factors they believe contribute to being a high-performing plan: building a physician–plan partnership, establishing the plan as a resource for physician practices, providing physician quality and cost data on performance, and emphasizing a local area orientation. Because employers are primarily responsible for arranging the health insurance coverage for their employees, there is market pressure for health plans to work with broader networks than they would otherwise want, which in turn interferes with the factors that lead to high performance.

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Lobbyists Favored Over Elderly | The Indianapolis Star | indystar.com

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The 2011 version of the Indiana General Assembly has taken on such volatile issues as gun rights, abortion, same-sex marriage and immigration.

This week, lawmakers confront throngs of protesters drawn to the Statehouse by bills dealing with labor unions.

Education reform legislation also has sparked heated debate.

So how is it that a bill aimed at improving Indiana's nursing home care has been deemed too controversial?

It's more likely that the power of the nursing home lobby is the real reason why state Rep. Clyde Kersey's bill to require minimum staffing levels is unlikely to get a hearing before the House Public Health Committee.

The chairman, Rep. Tim Brown, R-Crawfordsville, told The Star's Heather Gillers that it would be pointless to "put people through the struggle of such divisiveness" when consensus on the Terre Haute Democrat's bill is a long shot.

"Dead on arrival" is how an industry spokesperson put it.
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Medicaid Program-Payment Adjustment for Provider-Preventable Conditions Including Health Care-Acquired Conditions

This proposed rule would implement section 2702 of the Patient Protection and Affordable Care Act of 2010 which directs the Secretary of Health and Human Services to issue Medicaid regulations effective as of July 1, 2011 prohibiting Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for health care-acquired conditions. It would also authorize States to identify other provider-preventable conditions for which Medicaid payment would be prohibited.

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on March 18, 2011.

Full Federal Register Notice

Clearing the Fog in Nursing Homes - NYTimes.com

Image via CrunchBase
By PAULA SPAN

“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home,” said Laurel Baxter, the Awakenings project manager.

Any visitor can see what she means. Even in quality nursing homes, some residents sit impassively in wheelchairs or nod off in front of televisions, apparently unable to interact with others or to summon much interest in their lives. Nursing home reformers and regulators have long believed that this disengagement results in part from the overuse of psychotropic medication to quell the troublesome behaviors that can accompany dementia — yelling, wandering, aggression, resisting care. For nearly 25 years, federal law has required that psychotropic drugs (which critics call “chemical restraints”) be used only when necessary to ensure the safety of a resident or those around her.

The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)

Though they may be prescribed less frequently following the F.D.A.’s warnings, these drugs are still overused in long-term care, said Dr. Mark Lachs, chief of geriatrics at Weill Cornell Medical College. And once the pills are prescribed, residents keep taking them. “They get perpetualized, like insulin,” he told me, even though the behaviors they’re meant to soothe may wane anyway as dementia progresses.

“If a place is understaffed, if it takes particularly unruly patients, you can see how it happens,” Dr. Lachs added. “Behavioral interventions are far more time-consuming than giving a pill.”

Nevertheless, Ecumen’s Awakenings project emphasizes nondrug responses. “Medications have a place, but that shouldn’t be the first thing you try,” said Eva Lanigan, director of nursing at the Two Harbors facility.

So the home trained its entire staff (housekeepers, cooks, dining room servers, everyone) in a variety of tools to calm and reassure its 55 residents: exercise, activities, music, massage, aromatherapy. It taught people the kind of conversation known as “redirecting” — listening to elders and responding to them without insisting on facts that those with dementia can’t absorb or won’t recall.

“The hands-on, caring part is the most important,” Ms. Lanigan said. “Sometimes, people just want a hug. You sit and hold their hand.”

At the same time, consulting with a geriatric psychiatrist and a pharmacist, the home began gradually reducing the doses of antipsychotics and antidepressants for patients whose families agreed. Among them: the woman with the mysterious cries.

As Dr. Lachs pointed out, behavioral interventions are labor-intensive. Two Harbors hired an additional nurse to oversee those efforts, and Ms. Lanigan was available to answer staff questions around the clock. Ecumen estimates that introducing the program to a 60-bed nursing home cost an additional $75,000 a year for two full-time employees.

The results startled even the believers, however. Every resident on antipsychotics (about 10) was able to stop taking them, and 30 to 50 percent of those taking antidepressants also did well without them. When drugs still seemed necessary, “we tried to reduce them to the lowest dose possible,” Ms. Lanigan said.
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Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way" - The Commonwealth Fund

Authors: Sharon Silow-Carroll, M.B.A., M.S.W., and Jennifer N. Edwards, Dr.P.H.

Downloads-Case Study (1745K PDF)

Overview

McKay-Dee Hospital Center in Ogden, Utah, part of the Intermountain Healthcare System, had readmission rates in the lowest 3 percent of hospitals across the nation for all three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS) for the selection period, and its heart failure and pneumonia readmission rates were within the best 1 percent of hospitals reporting (Exhibit 1).
McKay-Dee’s success may be attributed to the following:

• comprehensive quality improvement strategies, supported by extensive, systemwide clinical research and training in evidence-based care;
• standardization of care through "care process models," or clinical protocols, and heavy use of hospitalists;
• information systems designed to monitor quality;
• interdisciplinary care coordination and discharge planning with individualized patient education and scheduling of follow-up appointments before discharge;
• comprehensive identification of heart disease patients for education, post-discharge phone calls, and referral to the outpatient heart failure clinic;
• integration with community providers, both within and outside of Intermountain's network, which provides a continuum of care and helps ensure patients are connected with a medical home; and
• Intermountain's role as a leader in health care delivery and payment innovations, exemplified in its involvement with pilots of bundled payment/accountable care arrangements.

The Intermountain Healthcare System is a highly integrated system with multiple hospitals, primary care practices and clinics, an outpatient heart clinic, home health service, and a renowned clinical research institute. Membership in this system provides clear advantages in terms of shared resources and expertise, and enhanced communication across care settings. Nevertheless, McKay-Dee's experiences provide lessons for other hospitals and systems—even less-integrated entities—that are striving to reduce readmission rates as well as improve outcomes and maximize systemwide efficiencies.

First, McKay-Dee Hospital Center and Intermountain Healthcare operate on the premise that lower readmission rates, better quality measure scores, and financial savings are not the primary focus of their efforts, but rather byproducts of caring for patients correctly. Second, alignment of hospital care with outpatient care improves transitions and health outcomes. Third, it is critical to select and nurture physician leaders who embrace a hospital's quality measurement and reporting philosophy. If other physicians do not respond through medical leadership and incentives, it may be necessary to hold them to a higher level of accountability to encourage their adherence to clinical protocols. Current payment policy that rewards volume rather than clinical outcomes conflicts with some of these desired practices. Over the long term, changes to the incentives in the health care system are needed to align goals across hospitals and other stakeholders.

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This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

 

Citation

S. Silow-Carroll and J. N. Edwards, Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way," The Commonwealth Fund, Feb. 2011.

Memorial Hermann Memorial City Medical Center: Excellence in Heart Attack Care Reduces Readmissions - The Commonwealth Fund

Authors: Aimee Lashbrook, J.D., M.H.S.A., and Jennifer N. Edwards, Dr.P.H.

Downloads

• Case Study (755K PDF)

Overview

Memorial Hermann Memorial City Medical Center (Memorial City) achieved superior readmission rates in two of the three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS). Its readmission rate for patients with acute myocardial infarction (AMI) and pneumonia surpassed the best 10 percent of hospitals in the country for the selection period. Its readmission rate for heart failure was not as strong, outperforming the national average only by a narrow margin. (Exhibit 1)
Memorial City's achievement of low readmission rates for heart attack and pneumonia appears to be related to the Memorial Hermann Healthcare System's efforts to improve quality and patient safety for all patients. At each of the system's hospitals, staff have sought to provide high-quality, safe care consistent with the highest clinical standards and to avoid problems such as infections or falls that can exacerbate patients' underlying health problems. Memorial City, in particular, has achieved exceptionally high standards in AMI care. They also have increased attention to educating and supporting patients and linking patients—even the uninsured—to needed care after discharge, which likely reduces readmissions.

Specifically, the following efforts and patient-focused interventions, which were initiated by the system and implemented at the hospital, seem to contribute to Memorial City's low readmission rates:
Organizational efforts

• Emphasis on quality, with a clear leadership vision that is communicated to all clinical staff and backed up by the commitment of needed resources. The health system aims to "do the right thing the first time."
• Concurrent review of performance on core measures during a patient's stay to monitor achievement of goals, with findings reported to physicians.
• Extensive employee training related to the system's top priorities to make sure everyone is "rowing in the right direction."

Patient-focused interventions

• Planning for discharge begins upon admission, with staff actively educating patients about their disease and connecting patients with a source of ongoing care, even if they lack insurance coverage. The hospital offers a community-based disease management program for uninsured patients with chronic illness.
• Risk-assessment software helps case managers establish the appropriate level of care and assess a patient’s readiness for discharge.
• Pharmacists are located in high-risk units to provide medication education to patients and help simplify home medication regimens.
• Iterative process improvements in AMI care have resulted in a lower door-to-balloon time, which preserves heart muscle, thus reducing complications and the risk of readmission. Memorial City’s average door-to-balloon time is around 65 minutes, compared with the Joint Commission's standard of 90 minutes.

Planning for discharge begins upon admission, with staff actively educating patients about their disease and connecting patients with a source of ongoing care, even if they lack insurance coverage. The hospital offers a community-based disease management program for uninsured patients with chronic illness.

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This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

Citation

A. Lashbrook and J. N. Edwards, Memorial Hermann Memorial City Medical Center: Excellence in Heart Attack Care Reduces Readmissions, The Commonwealth Fund, Feb. 2011.

Aged Care Bonds Must Be Capped - Australian Nursing Federation

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The Australian Nursing Federation says media reports of aged care residents paying up to $2 million in bonds highlights the urgent need for reforms that ensure equity of access and quality of care.

ANF federal secretary Lee Thomas said the reports allude to the competitive nature of the current system with differing levels of quality and care offered by residential facilities.

"When you hear about some people paying up to $2 million in bonds to secure a place in a residential aged care facility that is reputed to have good staff levels and infrastructure it rings alarm bells. Bonds should be capped to ensure some level of equity."

Ms Thomas said the current review of the aged care system must ensure all older Australians have access to high quality nursing care in accommodation that is comfortable and structurally sound.

"The major concern we have with the recent Productivity Commission report is the fixation on financial matters and the lack of attention to staffing and skills mix.

"While we all recognise the need for adequate funding for bricks and mortar and the need for people to contribute to the cost of their care if they can, we also want a safety net for those who can't afford to pay," Ms Thomas said.

One of the key issues in guaranteeing equity in access and care lies in addressing the staffing and working conditions in the sector, according to the ANF.

"We don't want to end up with a system that provides high quality care for those who can afford to pay and an inferior service for those who can't."

Source:
Australian Nursing Federation

Aging Dept. Touts Nursing Homes' Use of Survey Data | The Chillicothe Gazette | chillicothegazette.com

Sometimes, when results of a survey of one type or another is released, they get immediate lip service but never really change anything.

The Ohio Department of Aging, however, indicated its pleasure this week that nursing homes across the state have been taking a more active role in using state survey data to alter the industry.

"I am very pleased that Ohio's nursing homes are using the information provided in this and similar surveys to improve the care and services they are providing for their consumers," said Beverly Laubert, the state's long-term care ombudsman. "Working together with facilities, residents, residents' families and advocates, we are transforming the state's long-term care system into one in which consumers can expect excellence and person-centered care." Continue Reading

Health Care Facility Inspections to be Cut if Fees Not Raised - Las Vegas Sun

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If a panel of elected officials in Nevada rejects a proposal to increase health care facility licensing fees today as it did in October some state healthcare facilities inspectors will lose their jobs and the health care facility inspections will be greatly reduced, state officials said. The proposed fee increases are exponential in some cases, which has caused sticker shock for the facilities. Their lobbyist argues that the state, not the businesses, should bear the financial weight of protecting the public. "This amounts to what somebody calls a 'sick tax,'" said Charles Perry, president/CEO of the Nevada Health Care Association, the lobbying group for long-term care facilities.
Full Article

Can Good Care Produce Bad Health?

Excerpts from the Amy Berman post on the John A. Hartford Foundation blog

For those of you who haven’t yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was.

My recent journey through the health care system has been eye-opening. In only a few months, I have witnessed the remarkable capabilities and the stunning shortcomings of our health care system firsthand. I am writing here because in the time I have left, I hope my story and my journey can help illustrate why some of the reforms that my colleagues and I at the John A. Hartford Foundation, as well as many others, have championed are so important.

. . .

Based on a perverse set of metrics, the Philadelphia oncologist was offering technically the “best” care America had to offer. Yet this good care was not best for me. It wouldn’t give me health. Instead, it might take away what health I had. It doesn’t matter if care is cutting-edge and technologically advanced; if it doesn’t take the patient’s goals into account, it may not be worth doing.

. . .

I was determined not only to choose treatment that would maximize the healthy time I had remaining, but also to use that time to call on our health care institutions and professionals to make a real commitment to listening to their patients. In the health policy field, we call this patient-centered care. As a nurse and a senior program officer at a health care foundation, I understood my disease and my health care options well enough to make an informed decision about my treatment.

What about the millions of older Americans facing a terminal illness or chronic disease? How can they possibly stand up to the juggernaut of our health system and say, “No. I want care that focuses on my goals, care that is centered on me.” We need to make it easier for everyone to obtain care that fits their health care goals. How can we change the system and the measurement of quality to place the patient at the center? I call on everyone involved in health care practice and reform efforts to give serious thought about how we can reorient our health care system toward patient-centered care.

Read the full post at The John A. Hartford Foundation blog

Partnership Takes Aim At Preventable Hospital Readmissions Among High-Risk Seniors

SCAN Health Plan and Lakewood IPA have partnered with Dovetail Health in a program designed to reduce readmission rates for high-risk seniors following discharge from hospitals and skilled nursing facilities.

Under the new program, high-risk SCAN Health Plan members in Southern California whose primary care physicians are part of Lakewood IPA are now being referred into Lakewood's "Healthy Transitions" program upon discharge. Led by Dovetail, the Healthy Transitions program combines elements of existing transition management programs - such as improved discharge planning and telephonic case management - with a unique focus on medication optimization and adherence.

"We believe that this program will lessen the number of seniors readmitted to a hospital for reasons that are totally avoidable," said Timothy Schwab, MD, chief medical officer for the not-for-profit SCAN Health Plan. "By focusing on those problems most commonly found and tailoring the program to each individual, we can make a significant, positive impact in the lives of many of our members."

In general, patients enrolled in the program take an average of 12 medications and have chronic conditions such as diabetes, chronic obstructive pulmonary disease, congestive heart failure and renal disease. More than 75 percent are at increased risk of falls. One in five seniors nationwide is readmitted within 30 days of discharge at a staggering cost of over $17 billion, and medication-related issues are frequently a factor.

The Healthy Transitions program sends pharmacists to meet patients in their homes following discharge from hospitals and skilled nursing facilities. Healthy Transitions pharmacists review every prescription and over-the-counter medication. During the visits they clarify orders, educate patients and caregivers, identify opportunities to optimize medication schedules, and address issues such as non-adherence. Easy-to-read reports are printed for patients, and a version is prepared for their physicians with key questions or issues highlighted.

In addition to medication counseling and support, the Healthy Transitions program follows patients for 30 days to provide ongoing guidance around chronic illnesses, safety, advance-care planning and other potential readmission risk factors. At the end of 30 days, patients are referred back into the appropriate care-management programs at SCAN or Lakewood IPA.

"Our patients have been very open to having the home visit. The comprehensive counseling, support and assessment from the pharmacist are an asset to the physician and the case managers in the continued coordination of care for these high-risk members," said Robin Tufono, director of outreach programs at Coast.

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