The Michigan Value Collaborative

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

Tag: Heart failure clinics (page 1 of 2)

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)

 

Reducing Readmissions through Quality Discharge Planning

Deby Evans

Deby Evans is the Site Engagement Manager for the MVC Coordinating Center.

According to various literature, the quality of discharge planning can affect the likelihood of readmission. As hospitals search for ways to reduce their readmission rates one of the components to review might be the quality of discharge planning. A recently published study found that not only did higher quality discharge planning result in reduced readmission rates, but it also helped hospital retention rates for those patients that did need readmission. Retention of patients is important not only to maintain continuity of care but also for financial reasons. To read more on the study click here: http://journals.sagepub.com/doi/pdf/10.1177/1077558716647652

So what does quality discharge planning entail? Another recent study showed that quality discharge planning not only effectively informs patients about their discharge plan, but includes ways in which patients will carry out the plan and have the ability and willingness to execute it. In order for patients to become more actively involved in their discharge plans, hospitals should work in conjunction with their outpatient clinics and utilize many of the available community resources they may have. To read more on this study click here: http://qualitysafety.bmj.com/content/26/1/7.full

Two facilities that have incorporated liaising with outside agencies for quality discharge planning and to ultimately reduce readmissions are: The University of Virginia Health System and Christian Hospital in St Louis.

The University of Virginia (UVA) Health System has developed their Hospital to Home program to focus on the two-week time period after discharge. On the morning of discharge, the members of the entire patient care team meet with the patient thus incorporating all aspects of the patient’s care in to the discharge plan. To also help reduce confusion over the discharge plan, UVA Health System provides the patient with an easily understood discharge summary; one that contains no uncertainty or dubious information. This discharge summary is reviewed not only with the patient but with a family member as well. For heart failure patients, a one-hour long appointment at an in-hospital clinic is scheduled between four and seven days after discharge. During this appointment, a nurse practitioner reviews medication and diet. For more on UVA click here: http://www.hhnmag.com/articles/8327-case-study-post-discharge-planning-cuts-readmissions-at-uva

On another note, Christian Hospital in St Louis worked with 911 dispatchers and paramedics to reduce the utilization of their emergency department through the Community Health Access Program (CHAP). To help provide patients with the appropriate support they need, Christian Hospital set up access centers with coordinators who develop relationships with patients and are able to help procure resources. The development of CHAP has helped reduce overcrowding in the emergency department, reduce utilization of ambulances and paramedics and improve the quality of life for many in the community. For more on the CHAP program click here: https://www.christianhospital.org/Community/CHAP

Interested in learning more about Hospital to Home programs? Click here: https://cvquality.acc.org/initiatives/hospital-to-home

 

 

Older posts