The Michigan Value Collaborative

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

Category: Spotlight on MI hospitals (page 1 of 5)

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?

Combating Surgical Site Infections in Michigan: Joint Replacement Workgroup Recap and Hospital Initiatives

Deby Evans

Deb Evans is the MVC Site Engagement Manager

The Michigan Value Collaborative (MVC) and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) held a recent workgroup focused on surgical site infections (SSI) related to joint replacement. Hospitals met to discuss some of the root causes for these infections and initiatives they have implemented to help reduce them.

Below is one of the presented slides that exhibits the proportion of readmissions due to SSI’s for MVC/MARCQI hospitals based on MVC claims data:

Although many of the hospitals have done extensive analysis and in-depth review of pre-, intra- and post-operative joint conditions, few specific root causes for surgical site infections have been identified.  However, major focus areas for hospital-led initiatives that have been identified are:

  • Improving the general health of the patient especially in terms of reducing the body mass index (BMI);
  • Improving hemoglobin A1C for diabetics;
  • Improving albumin levels; and
  • Tobacco cessation

One hospital recently began an initiative aimed at helping patients become healthier and ultimately maintain an optimal weight for joint-replacement surgery. Referrals for the program come from surgeons prior to the surgery. The initiative includes a weight loss clinic and classes, which offers a refund of the cost of the program if the patient is successful in losing weight before surgery.

Most hospitals are following the Joint Commission recommendations from the Surgical Infection project (SIP) and the Surgical Care Improvement Project (SCIP). However, there are some differences in the identification and treatment of staphylococcus aureus carriers with some hospitals universally treating all joint replacement candidates and some only treating those identified as carriers through a nasal swab.  Although this workgroup only focused on SSIs related to elective joint replacement, it was mentioned that some hospitals are treating their trauma cases for staphylococcus aureus as well, while others are looking at this potential.

Other topics that prompted discussion among the group were wound closure and whether different types of closure affected SSI rates along with the type of dressing being used and the length of time the dressing stayed intact over the wound. There was some variety among surgeons and hospitals, however many are using a moisture-impervious silver based dressing that remains on for about seven days. Despite what may be considered a more expensive dressing being used the benefits of keeping the wound covered and out of contact with potentially infectious elements, i.e. pets, clothes, bed linen etc. outweigh these added costs.  In addition, when comparisons were made between these dressings and changing a dressing daily the difference in cost was negligible.

Finally, patient education was a major talking point during the workgroup. All hospitals agreed that having the patient’s cooperation is a significant factor in reducing SSI. Some hospitals have produced videos for patient viewing pre-operatively while others have an educational sheet that they provide to the patient before the surgery. Some discussion focused on the amount of information that the patients are expected to retain and ways hospitals are sharing reminders using booklets, pamphlets, a coach that is known to the patient or being seen by a discharge planner.

The Coordinating Center has put together a pre-, intra and post-operative check list of things to consider to potentially help reduce SSI, as well as a hygiene at home sheet for patients. These can be found in the resource tab on the registry along with information from our other workgroups.

If you have identified any specific root causes or have a new initiative aimed at reducing surgical site infections, then we would love to hear from you. Please contact Deb Evans (debevans@med.umich.edu) or Abeer Yassine (abeery@med.umich.edu) to share your story.  Preference

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