The Michigan Value Collaborative

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

Tag: heart failure (page 1 of 4)

Hospitals in Michigan: Growing a Palliative Care Program

Melinda Gruber

Melinda Gruber MBA, PhD, is the Chief Executive Officer for Caring Circles.

Palliative care provides a number of benefits for patients of all diagnoses including Congestive Heart Failure (CHF). During the CHF workgroups a topic for discussion was how palliative care programs can reduce readmissions and the MVC Hospital Engagement team found out more about some palliative care programs here in Michigan.

BACKGROUND

Lakeland Hospital started their palliative care program in the outpatient sector through a local independent hospice after recognizing that patients would benefit from improved symptom and pain management along with advanced care planning. By 2008, Lakeland realized they needed to engage a physician champion who was both well-known and accepted throughout the community with a vision for both inpatient and outpatient palliative care. In 2012, the outpatient hospice program joined Lakeland and a business plan was proposed to add an inpatient program. This program has grown and received positive feedback, and Lakeland now has a Hospice and Palliative Medicine Fellowship. Recently they have worked with home care and have started to provide a palliative home care service that is actively growing. As the program evolves, Lakeland continuously assesses the needs of the program to determine where to best allocate resources.

BENEFITS

The benefits of the palliative care program at Lakeland include an added layer of support for both patients and their families. Additionally, examples show reduced readmissions, better pain and symptom management, increased support for the family, and patients meeting their goals in end of life care surrounded by family who have been prepared.

While partnering with other outpatient and inpatient palliative care programs throughout the area, Lakeland is learning the strengths of each to provide for the varying needs of the patients.

CHALLENGES

One of the challenges Lakeland faces is an ongoing lack of understanding about palliative care and its true value to the patient. There is also the challenge to convince the provider that the palliative care team is there to assist with the patient’s needs and not completely take over care of the patient. To address these challenges, the palliative care program at Lakeland takes on the responsibility of educating and coaching staff to provide them with a minimum foundational skill to deliver palliative care and explain how and why the palliative care approach was taken. This helps those involved in patient care understand the different approaches to care given, and how the palliative care program works.

Other challenges being faced by Lakeland are identifying what the optimal approach for palliative care is, staffing needed to provide palliative care and setting expectations to deliver consistent care.

LIAISONS

Lakeland partners with Agency on Aging which includes an interdisciplinary team that goes to a patient’s home and provides dietary and medication advice. Lakeland’s palliative care program also has relationships with primary care for the homebound, nursing homes, hospitalists, hospices, intensivists, and consultation programs for all-inclusive care.

EDUCATION

Lakeland stresses the importance of palliative care education and provides opportunities for growth in learning such as:

  • Huddles with the hospitalists and working more with the residents;
  • Lunch and learns for CME credits; and
  • A patient care summit on the benefits of palliative care

NEXT STEPS

As the palliative care program at Lakeland continues to grow, the palliative care team perform needs assessments to ensure the program is meeting the needs of the patient and the health system. They also utilize data in a simplistic understandable way to demonstrate the value of the program to high level leadership. Moving forward, they have scheduled to attend meetings at provider offices to build relationships and provide educational opportunities to clinicians.

ADVICE

Lakeland advises other hospitals to recognize that there is not one set way to provide palliative care. They recommend setting expectations up front, developing objectives to meet the needs of both the patient and the health system, and finding “champions” and get them engaged in palliative care initiatives.

Lakeland is also seeking advice for how clinicians can be consulted ahead of a patient “crisis”. Team members are currently on call 24/7 but they would like to find ways that the team can be more consistent with providing consults especially in the off shifts.

If you would like to learn more about the palliative care program at Lakeland Hospital, please contact Doris Glowacki at dglowacki@Caring-Circles.org or the MVC Coordinating Center.

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

 

 

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