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 (firstname.lastname@example.org) or Deb Evans (email@example.com)
Shiyuan Yin is the Research Associate at MVC
This past Semi-Annual was my first MVC collaborative-wide meeting. I appreciated the opportunity to meet members of the Collaborative in-person and would like to share some takeaways from the presentations and breakout sessions.
The November 2017 meeting focused on the emergency department (ED) as a location to improve health care value, including strategies for reducing preventable ED utilization and unnecessary hospital admissions. In addition, the new MVC Obstetrics Initiative led by Dr. Dan Morgan aiming to address variation in obstetric care was launched. Below is a brief summary of each speaker’s presentation and breakout session discussion.
- Obstetrics Initiative Dr. Dan Morgan introduced the new MVC Obstetrics Initiative (OBI) and emphasized the tension in the existing obstetric practice. Not only is cesarean delivery often associated with increased rates of complications and higher cost than vaginal delivery, the triple aim of “patient experience, reduced costs, and population health” is also rarely met.
With a focus on the health of maternal and neonatal outcomes, OBI will:
- Develop labor & delivery practices that value, and support intended vaginal birth for low-risk patients
- Promote best practices for labor & delivery
- Improve the culture of care, awareness, & education
Leveraging the data available in MVC, OBI will:
- Determine hospitals’ cesarean delivery rates for “low” and “non-low” risk groups with proper risk adjustment.
- Recruit obstetric champions and enable peer-to-peer Michigan hospital comparisons regarding rates of vaginal and cesarean delivery as well as maternal and neonatal outcomes.
- Identify and support dissemination of strategies shown to promote vaginal births and reduce cesarean delivery rates for low-risk births.
The afternoon breakout session discussed how to use the MVC online tool at michiganvalue.org to review hospital’s obstetric reports. If you have any questions regarding the MVC OB initiative or would like to join this effort, please contact firstname.lastname@example.org.
- The Michigan Emergency Department Improvement Collaborative’s (MEDIC) PATH Initiative: Co-Directors for MEDIC, Drs. Keith Kocher and Michelle Macy, provided an overview of its Program on Alternatives to Hospitalization (PATH) quality initiative designed to provide decision support in the ED for diagnosis and treatment as well as coordinate admission decisions. During the breakout session, representatives from Beaumont and Michigan Medicine shared their experiences implementing the PATH initiative. Through the PATH program, Michigan Medicine revised its admission decision-making process for atrial fibrillation patients. As part of Beaumont Royal Oak’s engagement in PATH, the hospital implemented a Gold Card program for patient follow up and a pediatric observation program to ensure bed spaces for emergent cases. Favorable outcomes in both patient satisfaction and cost reduction have been noticed at both hospitals. For more information about MEDIC and its PATH program, please visit: http://medicqi.org/.
- Michigan Medicine’s Complex Care Management Program: Donna Fox, RN, and Heather Rye, LMSW, shared how they develop plans for patients with multiple comorbidities and integrate the ED clinicians in follow-up visits with patients and primary care physicians. The breakout session focused on specific strategies for building relationships with patients in the context of varying health systems. The value of cold calls to providers and inviting them to hospitals for monthly meetings to review patient cases was suggested as a mechanism to initiate coordinated care. More information on Michigan Medicine’s Complex Care Management Program may be found on its website: http://www.med.umich.edu/aco/index.html.
- Population-based approach to high ED utilization: Lauran Hardin, MSN, RN-BC, CL, is the Senior Director for Cross Continuum Transformation and the Camden Coalition. Prior to serving in this role, Lauran was Director of a Complex Care Center at Mercy Health St. Mary’s in Grand Rapids that created a cross continuum program coordinating patient care with providers across the county. An extensive root cause analysis of patient medical records allowed for targeted interventions and streamlined communication through the Complex Care Map. In the breakout session, the group discussed how the same interventions were effective on high ED utilizers regardless of payer type. For hospitals looking to implement a similar program, it was suggested to use a patient-specific story to physicians, or residents and fellows. When building the business case for a complex care program it was recommended to review length of stay and admission data layering based on greatest risk and to include the health system’s own employees in the analysis. Hospitals interested in integrating complex care into clinician education may visit: https://www.camdenhealth.org/programs/student-hotspotting/ for additional resources. More information on the complex care program and support, please visit: https://www.camdenhealth.org/ or https://www.nationalcomplex.care/.
All presentation materials are available on the MVC Registry under the “Resources” page. If you have any further questions or need further information about any of the speakers or content, please contact the MVC Coordinating Center at email@example.com.
We are excited to support the Collaborative’s work on the 2018 Value Coalition Campaigns and look forward to seeing you at our next meeting on April 20th, 2018 at the Radisson Hotel Lansing at the Capitol.