Nursing Homes and Hospitals INTERACT to Reduce Readmissions   

Beaumont Rehabilitation and Skilled Nursing Center has seen its hospitalization rate fall by more than 75 percent since it adopted Interventions to Reduce Acute Care Transfers (INTERACT), a quality improvement program that is successfully reducing avoidable nursing home-to-hospital transfers.

INTERACT promotes the use of free tools?from evidence-based care paths to patient transfer forms?that help nursing homes work closely with local hospitals, physicians, and residents and their families to manage care effectively and safely in the nursing home.

In 2009, Beaumont had 2.16 hospitalizations per 1,000 residents. Today, its rate is below 0.50 hospitalizations per 1,000 residents. Although many nursing homes would automatically send a resident with pneumonia and other common medical conditions to the hospital, Beaumont can often treat them onsite, eliminating stress and disruption to residents and their families.

"In the three years we have been using it, we have clearly saved millions of dollars because we're not sending people to the hospital, which costs three or four times the rate of a skilled nursing facility," says Beaumont administrator Paul O'Connell. "There's no ambulance ride to and from. And the additional tests and other care that patients get in the hospital are avoided." 

An App Approach Speeds Up Quality Reporting at Aria Health  

Like most health systems, Aria Health reports on a growing number of clinical quality metrics, such as infection and patient fall rates. Right now, the Philadelphia health system is tracking more than 70 performance metrics-just in clinical areas alone.

To reduce the huge administrative burden of quality reporting, Aria Health recently launched a new approach, using iPads and a web-based application to collect and analyze the data. The software automatically populates Aria Health's performance scorecard system, which allows leaders and staff to easily track rates on various metrics.

"The new approach has really sped up the quality reporting process-from the time data are collected to the time that end users get the results" says CNO Michelle Conley, who estimates that the turnaround has decreased from a few weeks to a few days.

The new approach has also invigorated the health system's performance improvement efforts. "To me, the most exciting part about this initiative," says Conley, "is that frontline nurses and clinicians are looking at this and saying, 'We need to improve our performance on this metric.'" 

Before Bundling for Payment: Reduce Variation

As Baylor University Medical Center has begun to explore bundled payment agreements, it has found variability in care to be a common issue. "As you start to map a care pathway for a particular type of procedure, you often discover a lot of variability among patients," says Jay Mabrey, MD, chief of orthopedic surgery, Baylor University Medical Center, the flagship hospital for Baylor Health Care System. "This can make it difficult to determine a consistent cost profile for a process.

"For example, in determining the total costs for a knee replacement, we have had to figure out where patients go after leaving our hospital. Do they receive physical therapy in a skilled nursing facility or an outpatient physical therapy center? Do they have a home health aide that helps with recovery or do they manage things on their own? For each of these options, there are costs associated with therapy and medication. These all have the potential to play into a bundled payment and must be mapped out."  

Enlisting Patient and Family Advisory Councils in Performance Improvement  

"By forming patient and family advisory councils, Spectrum Health System has been able to prioritize strategic initiatives, design patient rooms and facilities with feedback from patients and their families, improve the transition in care from one provider to another, and more," writes hfm author Kristine White, RN, BSN, MBA, vice president, innovation and patient affairs, Spectrum Health, Grand Rapids, Mich.

Spectrum Health began implementing and integrating patient and family advisory councils more than 10 years ago. About five years ago, the councils were retooled with a stronger infrastructure and internal leadership skills to fully maximize the input of the volunteer patients and family members. 

Additional Resources  

HFMA has released the first report from Phase 2 of the Value Project, Defining and Delivering Value. The report identifies five key strategies that hospitals and health systems should undertake to deliver greater value, with an emphasis on quality improvement and cost containment.  

In addition, view video interviews with some of the participants in HFMA's Value Project.  

Publication Date: Wednesday, July 18, 2012