The Michigan Value Collaborative

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

Author: Abeer Yassine (page 1 of 6)

Patient Support and Heart Failure (HF) Diets: Meal-Delivery Success for Reduced Readmissions

Abeer Yassine

Abeer is the MVC Engagement Associate

During a recent MVC HF Workgroup, hospitals shared patient education practices regarding HF diets with one another. The feasibility of implementing different programs, barriers in communication, and patient engagement along with potential solutions were discussed. The hospital representatives also shared different programs that their facilities engage in to work with patients on maintaining a healthy HF diet. While hospitals incorporate nutritionists or dieticians and educational materials in diet planning, some take unique approaches to helping patients adhere to their diets. For example, one hospital in the workgroup offers HF patients prepared, in-house meals at a subsidized cost. This helps address barriers such as accessibility to healthy food and any inability to prepare and cook meals due to disability. Addressing these barriers allows for enhanced chronic disease management.

Taking it one step further: What would happen if healthy, HF friendly meals were delivered right to patient homes?

In a recent study, Michigan Medicine observed the impact of nutrition support services, specifically home meal delivery post-discharge, on outcomes such as hospital readmissions and quality of life. In this small pilot trial, 66 HF patients were selected at random to either receive usual care consisting of a pamphlet on low-sodium diets or a meal delivery post discharge.1 The food was delivered to patients through PurFoods/ Mom’s Meals, a service that was also mentioned during the HF Workgroup discussion.1 The results of the pilot were promising: there was a total of 11 HF-related 30-day readmissions among the control group, versus only 3 HF-related readmissions in the experimental group receiving the delivered meals. 2 Although the pilot group was small, it is evident that providing post-discharge support to patients can prove to be significant to patient outcomes and avoidable readmission costs.

Furthermore, providing hospital-to-hospital support has also proven to be helpful through the workgroup discussions as well. During our dialogue, which included representatives from respective nutrition teams, a few hospitals were willing and open to sharing some of their patient education materials, including HF diet tip sheets. This allowed participants to share experiences, and best practices while learning about different initiatives that could have a positive impact on patient outcomes. A synopsis of the HF workgroup discussion on patient education and diet, including resources and a literature review, can be found in the MVC Registry under Resources.

If you are interested in learning more about this initiative, or HF workgroup, please do not hesitate to reach out to Abeer (abeery@med.umich.edu) or Deby (debevans@med.umich.edu).

 

Sources:

1 Geriatric Out of Hospital Randomized Meal Trial in Heart Failure (GOURMET-HF)

2 Does DASH Diet Meal Delivery Help Heart Failure Outcomes?

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

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