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)
Deb Evans is the MVC Site Engagement Manager
An article published in the Journal of Arthroplasty in June 2017 discussed 5 clinical pillars that one hospital in New York identified for enhancing value in their joint replacement practices through the bundled payment program.
- Optimizing patient selection and comorbidities: The hospital identified common comorbidities within their Total Joint Arthroplasty (TJA) patient population. The most frequent were found to be musculoskeletal comorbidities, hypertension, hyperlipidemia, tobacco use and diabetes. Each of these comorbidities is associated with an increased risk for readmission. By incorporating the use of a readmission risk assessment tool (RRAT) into the Perioperative Orthopedic Surgical Home (POSH) initiative, the hospital identifies patients that are at high risk for readmission and delays surgery in favor of working to optimize the patient’s modifiable risk factors. By getting the patient in optimal condition for surgery, the risk of an unplanned readmission can be reduced, saving the hospital the associated costs.
- Optimizing care coordination, patient education, shared decision-making and patient expectations: Multiple studies have shown that splintered care pathways, unnecessary services and a lack of patient-centered care negatively impact clinical outcomes. Characteristics of programs that displayed improved patient outcomes were synchronized management among the patient’s care team and managing the expectations of the patient and family. The goal for this hospital was to institute a streamlined pathway for the duration of the episode of care that focused on collaborative decision making and standardized pathway criteria.
- Multimodal analgesia: An increased length of stay not only affects cost but also increases the risk of readmission. One of the factors known to influence length of stay is pain management. This facility reviewed their pain management protocol and made changes with the intention of decreasing opioid use while maintaining pain relief as well as facilitating early ambulation and rehabilitation and decreasing falls. These principles help to reduce length of stay by expediting discharge and decreasing the use of post-acute care facilities.
- Risk-stratified Venous Thromboembolic disease (VTED) prophylaxis: Use of an aggressive mode of VTED prophylaxis may be effective in preventing venous thrombosis, but has also shown to increase the risk of major complications. The institution performed a study to analyze their adapted risk-stratification algorithm with positive results. The use of this algorithm to identify which VTED prophylaxis trajectory was most appropriate helped the hospital optimize care and reduce costs.
- Minimize Post-acute care facility and resource utilization: Increased costs have been shown to be related to the use of post-acute care facilities and the associated resource utilization. In an effort to help control post-acute care costs, this institution worked on identifying selected post-acute care partners. Once identified the hospital and the partnering skilled nursing facility increased communication and collaboration through meetings and performance and resource utilization monitoring. By establishing these partnerships post-acute care length of stay was reduced with associated cost savings.
Through focusing on these five clinical pillars, this New York hospital was able to identify areas of improvement and subsequently implement initiatives targeted towards care and cost improvement. If your hospital is interested in identifying five clinical pillars of focus, the MVC Coordinating Center can help identify common readmission diagnoses, along with post- acute care SNF utilization and length of stay information.
Moreover, the MVC Coordinating Center, in conjunction with MARCQI and MOPEN, is also holding workgroups on November 30th and December 7th to discuss pre- and post- surgical pain management. If you are interested in joining either of the workgroups, please register here.
Please contact Abeer Yassine at firstname.lastname@example.org or Deb Evans at email@example.com for more information and if you have any questions.