The Michigan Value Collaborative

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

Author: Deby Evans (page 1 of 8)

MVC Heart Failure Workgroup Updates and 2018 Opportunities

Deby Evans

Deb Evans is the MVC Site Engagement Manager

The Michigan Value Collaborative (MVC) Congestive Heart Failure (CHF) workgroup has had a productive year of virtual meetings and many useful discussions about a variety of topics that can influence reducing readmissions. Every other month, in collaboration with I-MPACT, another Blue Cross Blue Shield of Michigan quality improvement collaborative focusing on transitions of care, the group has held discussions on a variety of topics pertaining to CHF. The MVC Coordinating Center will be opening up the workgroup for other hospitals to join in 2018 and additional information can be found below. A synopsis of the findings of each 2017 workgroup discussion is detailed below, although more details can be found on the MVC registry under the resource tab or by contacting the Coordinating Center.

Using Skilled Nursing Facilities: This discussion encouraged working closely with skilled nursing facilities to help provide education to staff, patients, family members and care givers in respect to fluid intake and nutrition.  Additionally, the discussion included how to allow staff to facilitate medication administration and finding alternative ways of medication delivery such as giving Lasix via intramuscular injection rather than intravenously.

CHF Referrals to Palliative Care: The discussion centered around getting this patient population referred to palliative care as soon as possible in the course of their disease process. The conversation included triggers for referral along with some benefits of being in a palliative care program and initiatives that Michigan hospitals had implemented or were working on implementing in relation to palliative care programs in their facilities.

Use of Outpatient Heart Failure (HF) Clinics: The group discussed the effectiveness of having a HF clinic to refer their CHF patients too and how attendance at these clinics had helped reduce CHF readmission rates. Some hospitals discussed the collaborative work they had done to implement a HF clinic in their facility. Templates of business plans were provided and members provided information on how they had presented and made the case to open a HF clinic at their facility. An interview with a Michigan hospital ranked number 3 in the country was utilized for a blog post.

Diet and Nutrition Education: Some dieticians from member hospitals joined us to discuss the tools and information they share with HF patients at their facilities. Information sheets containing information on alternative spices to use instead of salt were shared and also initiatives and education on how to provide heart healthy meals to patients either by the facility or via a vendor such as Meals on Wheels.

Medication Reconciliation: Pharmacists joined the discussion about their role or potential role in medication reconciliation and also provided some recommendations for the use of different stakeholders in the medication reconciliation process, not only for CHF patients but for other patient populations too. Some facilities discussed how they have also integrated parts of the reconciliation process into their electronic health record systems.

The CHF longitudinal workgroup will be continuing into 2018 with more discussion topics pertaining to CHF and opportunities for collaboration. If you are interested in joining the workgroup, please sign up here.  Further details will be provided in 2018.

If you have any questions about the workgroup or 2018 workgroup registration  please contact Abeer Yassine (abeery@med.umich.edu) or Deb Evans (debevans@med.umich.edu)

 

Behavioral Economics and Reshaping Patient Behavior to Improve Health

Deby Evans

Deb Evans is the MVC Site Engagement Manager

A recent article published in QJM, Journal of Medicine discusses changing the culture within healthcare by the use of behavioral economics. By combining lessons learnt through psychology and economics, behavioral economics tries to understand how emotions, self-identification, the environment and receiving of information has an influence on a person’s behavior. Many of our decisions are made from an emotional standpoint, or effectively “without thinking”. Thus, behavioral health relies not on education level but on how and why individuals make certain decisions. One method of understanding behavioral economics is the placement of healthy food in a grocery store. This placement can affect how people choose items to purchase. Behavioral economics can also incorporate the use of games or friendly competition and can appeal to the emotional nature of people through instant gratification and rewards. These tactics may trigger some motivation in people

Due to the number of individuals living with type 2 diabetes in the U.S. this condition is reaching epic proportions. The number of people diagnosed with type 2 diabetes continues to grow with a predicted world-wide growth of 54% from 2010 to 2030. In addition to this rapid growth, the global cost to manage this condition is also set to rise from $376 billion to $490 billion by 2030. Increased rates of type 2 diabetes can be related to urbanization, decreased physical activity, and increased access to processed foods.2 Using the principles of behavioral economics, healthcare facilities may be able to target those at risk of prediabetes, improve healthcare outcomes and reduce cost.

Other examples of ways healthcare facilities can use behavioral economics is through auto-filling prescriptions for longer periods of time such as 90 days instead of 30 days, this helps maintain a supply of medication and reduces the risk of the patient running out and less often, having a follow-up appointment already arranged prior to discharge so patients do not have to think about trying to arrange a visit or providing healthy meals for patients unable to shop or cook for themselves

Sources:

  1. https://www.fiercehealthcare.com/hospitals/hospital-impact-behavioral-economics-may-improve-health-and-reduce-healthcare-costs
  2. https://academic.oup.com/nutritionreviews/article/75/suppl_1/13/2797604
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