A Team Approach to Reducing Complex Discharge Delays at Denver Health 

Every week, a cross-disciplinary committee at Denver Health reviews a list of 10 to 30 patients who have been in the hospital for more than 10 days. These patients have the potential to be discharged or transferred but can't for a variety of complicated reasons, such as a lack of insurance or lack of a legal guardian.

Since 2008, the Complex Discharge Committee has identified a number of novel approaches to ensure safe discharges for complicated cases. For example, the team sent a Spanish-speaking clinician to accompany a patient who was hospitalized with a traumatic brain injury back to his family in Central America. The clinician brought a wheelchair and other equipment that the patient's family would need to take care of him at home.

By helping patients reach the next level of care, the Complex Discharge Committee has helped lower the hospital's length of stay for adult nonobstetric patients from five days to four days over the past three years-and reaped an annual return of $2 million to $3 million.

Using Teach-Back to Improve Patient Adherence-and Reduce Readmissions 

The teach-back method has been linked to improved patient outcomes-and reduced hospital readmissions. For example, none of the 56 heart failure patients who received teach-back education at Santa Clara Valley Medical Center, San Jose, Calif., were readmitted during a 90-day implementation period in 2011.

"During teach-back, the nurse asks open-ended questions in a nonshaming way so it doesn't sound like a test," says Gail Nielsen, director, learning and innovation, Iowa Health System. "The patients say back in their own words their necessary healthcare instructions. This enables the nurse to check for understanding and, if necessary, to re-teach the information."

Funded by a $50,000 matching grant through the Picker Institute's Always Events® initiative, Iowa Health System is developing a teach-back training toolkit to help providers clearly communicate self-care information to patients and their families, including danger signs and symptoms to watch for after discharge and steps to take in case these symptoms occur.

Initiative Increases Medical Homes Across Hudson Valley Region 

Fifteen primary care practices spent more than a year transforming their care delivery approaches to obtain medical home recognition from the National Committee for Quality Assurance (NCQA) through a patient-centered medical home initiative across New York's Hudson Valley region.

To help fund the transformation, the not-for-profit Taconic Health Information Network and Community Project got six health plans-which represent about 65 percent of the commercial insurance market in the Hudson Valley, and 43 percent of Medicaid managed care-to agree to pay the participating practices a pay-for-performance bonus for achieving NCQA medical home recognition.

The project instilled a culture of collaboration by uniting solo practitioners and several small practices with large practices with dozens of physicians. The leadership of each practice formed a council to collaborate, share best practices, and facilitate solutions.

Enhanced Website Helps Rural Hospital Increase Volumes 

Henry County Health Center, a 25-bed critical access hospital in rural southeast Iowa, expanded its web services-particularly in the area of revenue cycle-allowing patients across a wider geographic area to pay their medical bills online or update their insurance information, for example.

The hospital received national recognition for its efforts, earning a "Most Wired" award from Hospitals & Health Networks magazine for five straight years. But the biggest reward for the organization is the dramatic increase in use of the website by patients and their families. From August 2008 through January 2009, the number of page views increased by more than five times in the first two years after Henry County Health Center began this initiative.

By extending its reach, Henry County Health Center also increased patient volume. In FY11, patients from 233 cities across Iowa relied on the hospital for care and service, up from 156 cities in early 2009.
 

Publication Date: Tuesday, January 24, 2012