The Michigan Value Collaborative

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

Tag: Physician Engagement

Reshaping Care Delivery: Using Models of Care to Understand Patient Engagement

Abeer Yassine

Abeer is the MVC Hospital Engagement Associate

Patient engagement is frequently cited by health systems as a root cause for sub-optimal outcomes. Studies have supported the importance of understanding individual and population behavioral trends to increase patient engagement and improve outcomes. To improve patient engagement outside of a procedural setting, hospitals such as Massachusetts General Hospital (MGH) are seeking non-conventional methods to better address the needs of a specific population.

Upon receiving the results from a community needs assessment, MGH’s Substance Use Disorder (SUD) population was determined to be a primary focus for intervention to improve patient engagement, coordination, and outcomes. This population includes patients with an alcohol use disorder, opioid use disorder, or other drug/alcohol use disorders.1 By engaging this population in different hospital-led interventions, MGH has seen significant outcome improvements related to readmissions while helping physicians gain a deeper understanding of SUD in general.

To strategically address this population’s needs, MGH launched a multi-faceted Institutional SUD intervention. This institutional intervention includes a variety of features such as an inpatient consulting team, recovery coaching, and primary care support. To provide for a more personalized patient experience, recovery coaches include individuals who are in SUD recovery as well. These coaches provide an additional layer of support by assisting SUD patients in navigating the health system for appropriate care. 1

A study analyzing the impact of the program found the inpatient consulting teams have helped improve physician attitudes and preparedness when treating SUD patients.1 This was evidenced through a physician survey in which 66% of the respondents who had encountered clinical components of the initiative demonstrated positive attitude changes related to caring for SUD patients.1 This emphasizes the impact of an institutional approach to address a patient population.

Another intriguing feature of the SUD intervention is a post-discharge “Bridge” Clinic. This unique transitional clinic helps address the “What happens to the patient after discharge?” question that clinicians long to answer. The outpatient clinic serves patients who have been discharged from the emergency department and have not received follow-up care. The clinic accepts walk-ins, and provides a variety of clinical and social services to holistically treat the SUD patient population. There are no barriers for individuals accessing the clinic, helping them receive appropriate care. Not all services at the clinic are billed (e.g.: resource specialists, clinical pharmacist, etc.) by the hospital; as this is MGH’s method of contributing to the reduction of costs related to avoidable readmissions. More specifically, patients who have sought care at the clinic were readmitted 7.5% less frequently compared to those who did not receive interventional services.2 More information about this program can be found here.

Nonetheless, health systems across the country are exploring unique models of care to help improve patient coordination and engagement. Features of MGH’s non-traditional, yet effective, model of care helps address a main concern for various different populations: lack of access to services. By connecting patients with timely post-discharge care, MGH’s Bridge Clinic helps coordinate with patients during a critical, yet often overlooked, time period.

Questions or feedback for future posts? Feel free to reach out to Abeer (!

Wakeman SE, Kanter GP, Donelan K. Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice. (July 2017)

2 Common Wealth Fund Feature, September 2017 and MGH SUDs Initiative

How to win at quality improvement in your hospital

Phyllis Wright-Slaughter

Phyllis is a Senior Data Architect working with the Michigan Value Collaborative.

Health care quality improvement and reducing episode costs for inpatient care are currently the focus of many state and national programs, including the MVC.  The Center for Studying Health System Change (HSC) conducted interviews with hospital executives in Detroit, Memphis, Minneapolis-St. Paul and Seattle.  The focus of these interviews was the hospital’s quality improvement activities and the role of nurses in these activities.  Although the focus was on nurses and nursing teams, the comments and recommendations can be applied to other staff (Physician Champions, Pharmacists, Respiratory Therapists, etc.) who can affect the quality of care provided in a hospital – essentially everyone.

Here are the major points from this paper:

  1. Quality Improvement demands are increasing – true in 2008 when this article was written and even more so now. The roles on nurses and other staff also increase.
  2. Improving hospital quality requires a supportive hospital culture. Strategies that can lead to a supportive culture include:
    • active and supportive hospital leadership
    • active and ongoing staff engagement through setting expectations for staff and holding everyone accountable for individual roles
    • inspiring and using physicians and nurses to champion efforts
    • providing ongoing, visible and useful feedback
  3. It’s important to pinpoint challenges faced by the hospital, and be creative in addressing them. Challenges faced include:
    • Limited resources: engaging all staff and not just department leadership can help
    • Growing demands for data collection, and understanding how to use data to improve patient care
    • Reporting and tracking quality improvement activities
    • Need to improved training and education

With an integrative approach that includes all hospital staff, hospitals can meet the challenges and opportunities of improving quality and episode costs.  MVC is a proud partner of Michigan hospitals and excited to continue to support improvement efforts going on around the state.

 Reference: “The Role of Nurses in Hospital Quality Improvement”, HSC Research Brief No. 3, March 2008 ( )

See also this article in health affairs on the nurses roles  in improving hospital quality and efficiency.

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