There’s No Place Like Home

There’s No Place Like Home
By Michael Clark

If you are on Medicare and have had a recent hospital stay, experts say there is about a 1-in-5 chance you will find yourself back in the hospital again within a month. Hospital readmissions are not only expensive they are hard on both patients and families. According to analysts, three-fourths of these readmissions are potentially avoidable.
Now, the Nevada Partnership for Value-driven Healthcare (NPV) has an initiative with an ultimate goal of reducing these hospital readmissions by at least 10%. The No Place Like Home Campaign is being implemented in Nevada by HealthInsight, the state’s Medicare Quality Improvement Organization.

Typically, problems begin when patients receive inadequate preparation for discharge from the hospital. The handover from the hospital to outpatient providers is poorly handled, and patients and their family caregivers are left to cope on their own with medical issues that they don’t understand. In fact, only about half of discharged patients follow up with their primary-care physicians after they leave the hospital, and those who don’t are much more likely to be readmitted than those who do see a doctor.
“Have we properly prepared the patient for a return home?” asks Deborah Huber, executive director of the non-profit organization HealthInsight, a prominent member of the NPV. “Poor communication is at the heart of the problem.”
Huber points out that too often people released from hospital care do not know when to go to their primary-care doctor, or which medications to take, or the costs involved. Making matters worse, there are no clear lines of authority. As a result, the system sets these individuals up to fail and creates a dangerous situation for patients, according to Brian Jack, an expert on hospital engineering.

In one study, for example, 78 percent of patients discharged from the ER did not understand their diagnosis, their ER treatment, home care instructions, or warnings signs of when to return to the hospital. Health care providers are partly responsible for this lack of comprehension.

IHI, a Boston-based nonprofit organization, advises hospitals and other institutions to use a patient-centered approach that looks at post-discharge care through a patient’s eyes. By doing “deep dives” into several patient histories, IHI says, and finding out why the patients were readmitted, it’s possible to understand where the entire process falls short and begin to fix it.

Another area that needs improvement has to do with what is called the transitions of care…do the health care providers receiving the patient know what the ones sending the patient home knows? “The patient gets stuck in the middle. They don’t know what to do,” Huber noted. And what about Advanced Planning…end of life care? Have patients and their families made these ultimate decisions? If not, these issues must be addressed. What if patients don’t want to go back to the hospital? Are they aware of what palliative care or hospice can do? “Medicare provides a good hospice benefit. The whole family can benefit from that.”

Here the goal is to make someone as comfortable as possible and give family members the support they need to help them through this difficult time. “These are the type of things I see every day with my home health patients, I see where patients would not have to return to acute if the goals set here could be obtained,” said Lucia Cleveland a home health occupational therapist.

HealthInsight’s goal is to reduce 30-day readmissions by 20% by October 2013. Finally, Huber observes “this is a community problem, not merely a hospital problem.” This community effort will produce sustainable and replicable strategies to achieve high-value health care for individuals in our communities and save potentially millions of dollars in healthcare costs.

“One way we support this statewide community effort is through a web-based campaign where providers, payers, and patients can pledge their support and become an active participant,” noted Jackie Buttaccio, HealthInsight’s Quality Improvement Manager. “The website is a one stop shop for all things readmissions with resources and tools that can be downloaded, and local success stories can be shared. “ The address is http://noplacelikehomenv.com

HealthInsight also supports this work through face to face workshops for providers to learn more about what they can change about their systems of care to keep patients safe from an avoidable hospital readmission.