The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Author: Abeer Yassine (page 1 of 5)

Reshaping Care Delivery: Using Models of Care to Understand Patient Engagement

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Patient engagement is frequently cited by health systems as a root cause for sub-optimal outcomes. Studies have supported the importance of understanding individual and population behavioral trends to increase patient engagement and improve outcomes. To improve patient engagement outside of a procedural setting, hospitals such as Massachusetts General Hospital (MGH) are seeking non-conventional methods to better address the needs of a specific population.

Upon receiving the results from a community needs assessment, MGH’s Substance Use Disorder (SUD) population was determined to be a primary focus for intervention to improve patient engagement, coordination, and outcomes. This population includes patients with an alcohol use disorder, opioid use disorder, or other drug/alcohol use disorders.1 By engaging this population in different hospital-led interventions, MGH has seen significant outcome improvements related to readmissions while helping physicians gain a deeper understanding of SUD in general.

To strategically address this population’s needs, MGH launched a multi-faceted Institutional SUD intervention. This institutional intervention includes a variety of features such as an inpatient consulting team, recovery coaching, and primary care support. To provide for a more personalized patient experience, recovery coaches include individuals who are in SUD recovery as well. These coaches provide an additional layer of support by assisting SUD patients in navigating the health system for appropriate care. 1

A study analyzing the impact of the program found the inpatient consulting teams have helped improve physician attitudes and preparedness when treating SUD patients.1 This was evidenced through a physician survey in which 66% of the respondents who had encountered clinical components of the initiative demonstrated positive attitude changes related to caring for SUD patients.1 This emphasizes the impact of an institutional approach to address a patient population.

Another intriguing feature of the SUD intervention is a post-discharge “Bridge” Clinic. This unique transitional clinic helps address the “What happens to the patient after discharge?” question that clinicians long to answer. The outpatient clinic serves patients who have been discharged from the emergency department and have not received follow-up care. The clinic accepts walk-ins, and provides a variety of clinical and social services to holistically treat the SUD patient population. There are no barriers for individuals accessing the clinic, helping them receive appropriate care. Not all services at the clinic are billed (e.g.: resource specialists, clinical pharmacist, etc.) by the hospital; as this is MGH’s method of contributing to the reduction of costs related to avoidable readmissions. More specifically, patients who have sought care at the clinic were readmitted 7.5% less frequently compared to those who did not receive interventional services.2 More information about this program can be found here.

Nonetheless, health systems across the country are exploring unique models of care to help improve patient coordination and engagement. Features of MGH’s non-traditional, yet effective, model of care helps address a main concern for various different populations: lack of access to services. By connecting patients with timely post-discharge care, MGH’s Bridge Clinic helps coordinate with patients during a critical, yet often overlooked, time period.

Questions or feedback for future posts? Feel free to reach out to Abeer (abeery@med.umich.edu)!

Wakeman SE, Kanter GP, Donelan K. Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice. (July 2017)

2 Common Wealth Fund Feature, September 2017 and MGH SUDs Initiative

Pain Management Efforts: Addressing the Opioid Epidemic

Abeer Yassine

Abeer Yassine, is the MVC Hospital Engagement Associate

Drug overdoses are a leading cause of accidental death in the U.S., with as many as 20,000 of these deaths in 2015 related to prescription pain relievers.1 Various studies have also drawn relationships between opioid usage and higher hospital costs (ex: 30-day readmissions). 2,3 Since the opioid epidemic does not come only at a cost to patient lives, but also to hospital systems across the country, pain management interventions have become widespread as a primary focus for hospitals. With hopes of helping address the Opioid Epidemic, there have been several promising interventions across the U.S. that are focused on different facets of pain management.

Straith Hospital, Southfield, Michigan

The original Straith Hospital focused on plastic and reconstructive surgery but over the past twenty-five years has branched out into other realms of heath care. In a recently published Crain’s Detroit article, Straith Hospital was highlighted for their new Interventional Pain Center in Southfield, Michigan.4 This new Interventional Pain Center is focused on comprehensive procedural interventions using multi-modal approaches to help limit and reduce the use of opioids in Michigan. Examples of procedural interventions include physical therapy and steroid injections. Straith decided to take this approach to pain management rather than medication management based on the needs of the population that they treat. To learn more about the variety of services at Straith’s Interventional Pain Center and the procedures they hope to offer click here.

Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study

For a variety of reasons opioids are often the drug of choice for treating patients with chronic non-cancer related pain. However, with limited knowledge on the effectiveness of these medications and scarce availability of alternative pain relief treatment options, a study is being conducted to elicit information about an online tool to help chronic pain patients. The EMPOWER study is a federally funded study focused on pain management through an online program for non-cancer patients. This $2.5 million study will examine the impact of an online tool, Goalistics Chronic Pain Management Program, over the course of five years. Goalistics offers daily activity trackers, planning, and relaxation tools and exercises to help individuals better manage their pain without the use of medication.

This online program was created by psychologists and offers patients easy-to-use tools to manage their chronic pain and has been shown to be effective in pain management in small samples. With investigators from University of Cincinnati College of Medicine and Washington State University College of Nursing, the EMPOWER study will expand the sample size to further examine the impact of online, holistic pain-management. For more information on the EMPOWER study, click here and here.

1 American Society of Addiction Medicine (2016). Opioid Addiction 2016 Facts & Figures. Google Scholar

2 Rogal, S., Mankaney, G., Udawatta, V., Good, C.B., Chinman, M., Zickmund, S., Bielefeldt, K., Jonassaint, N., Jazwinski, A., Shaikh, O., Hughes, C., Humar, A., DiMartini, A. and Fine, M.J. (2016), Association between opioid use and readmission following liver transplantation. Clinical Transplantation, 30: 1222–1229.  Google Scholar

3 Waljee J.F., Cron, D.C., Steiger, R.M., Zhong, L., Englesbe, M.J., and Brummett, C.M. (2017), Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Annals of Surgery, 265: 715-721.Google Scholar

4 Green, Jay (2017). Straith Hospital expands into interventional pain center program. Crain’s Detroit Business

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