• Achieving Care Integration Boosts Hospital’s Quality Metrics

    By Edwin Loftin Dec 11, 2018

    In pursuit of integrated care certification, Parrish Medical Center launched a series of process improvements that helped the organization slash readmissions and take steps to improve community health.

    1218_Physician_Edwin LoftinOur administration team at Parrish Medical Center (PMC) in Titusville, Fla., long suspected that simply communicating better across the care continuum and with community stakeholders would lead to improved outcomes and safer care. Even back in 2009, our new strategic plan called for developing relationships beyond the hospital walls and communicating with pharmacies, skilled nursing facilities, and churches.

    Although we knew this strategy would likely improve our quality performance, leadership didn’t have a clear roadmap to link care-continuum communication with improved outcomes. Around the same time, The Joint Commission’s integrated care certification launched, providing measurement of clinical and safety outcomes.

    That piqued our interest, given that our 210-bed not-for-profit hospital was seeking third-party validation to distinguish our organization from market competitors that claim to be integrated even though they do not share patient medical records or collaborate in real-time. (In many cases, those organization are “integrated” only in that they own various entities in the continuum of care.) 

    PMC’s journey to integration began in 2009, when we laid out a new strategic direction for the medical center. We challenged ourselves to “transform from a service line and activity-based model of care to a health-management and outcomes-based system of care.” 

    We further established that “the continued development of our integrated provider-hospital network” and “development of collaborative partnerships for effective delivery of integrated and coordinated patient care,” would be strategic imperatives. This direction became the basis of our strategic plan, which we call our “Game Plan”. The organizational strategy led to development of our integrated network, named the Parrish Health Network (PHN). 

    PHN is a regional community-based network that includes acute, tertiary and specialty hospitals; Mayo Clinic Care Network; community and specialty physicians; major health insurers; affiliate services such as hospice care and skilled nursing care; and community organizations, such as churches. By including community organizations in our collaboration, our integrated care initiative even more quickly achieved quantifiable results. 

    PMC leaders thought the certification process could provide an external methodology with which to measure success in reducing readmissions, controlling the cost of care, and managing patients with chronic diseases.

    Gaining Physician and Staff Buy-In

    Once the integrated care certification journey was approved and underway, the leadership team handled the high-level certification activities, with the chief transformation officer communicating the value that the initiative would bring to the community.

    Early on, PMC recognized that the best approach was to involve the entire organization in the certification process. Program champions were identified, with a special emphasis on physician champions (one inpatient, one outpatient).

    While the integrated care certification roadmap may initially seem perfectly linear, we learned that’s far from true. For starters, surveyors pointed out that we needed to enhance the previous strategic plan with new focus areas—including medication reconciliation, which served as an apt  illustration of our goals. It made sense that all providers involved in a patient’s care should have a shared understanding of the patient’s medication regimen.

    In many instances we noted duplicative efforts between hospital and ambulatory providers that needed to be addressed. Often, it seemed like every time we were comfortable in our knowledge about a patient trend or internal process, a game-changing piece of information bubbled to the surface—for example, the impact of hospice consults on hospital admissions.

    Electronically Incorporating Patient Goals

    The certification process reinforced the importance of maintaining a focus on patients’ own goals and sharing best-practice information with patients. Leveraging IT capabilities to build a patient’s goals into the medical record allowed clinicians to avoid having to ask about goals during every patient encounter and significantly improved clinical communication. If, for example, a patient’s goal was to be able to walk to the mailbox, the post-acute care providers could see it in the notes.

    In that same vein, including information about a patient’s changing condition in the medical record aided in preventing readmissions.

    Interdisciplinary and Community-Wide Teams

    Throughout the certification process, we also learned more about the importance of team composition. PMC assembled a performance improvement team consisting of representatives from:

    • Hospice
    • Home health
    • Skilled nursing
    • Other providers
    • The community 

    During a quarterly meeting, this team noted that 80 percent of patients in skilled nursing facilities needed hospice care, which wasn’t being provided. The strategic team developed a “Partners in Healing” program with 23 religious congregations to support parishioners as they moved between home and hospital.

    This partnership helped PMC make huge strides in enhancing communication and shaping whole-person care. Patients were more willing to discuss their situation with a member of a clergy than with someone in a white coat. Patients reported feeling like their providers were being sensitive to their needs, far beyond what’s typically discussed during a medical encounter. 

    While patients appreciated confiding in church leaders, medical staff had to work to keep their egos in check during these conversations. One patient was receiving excellent medical care, for example, but the patient advocate kept insisting that the “whole person” element was being ignored. Nonetheless, the team made a point of including the patient advocate in discussions about disease treatment vs. whole-person care. Their diplomacy paid off—the relationship flourished, and the patient advocate ultimately was invited to join PMC’s patient advisory team.

    Improved Outcomes

    PMC’s readmissions, which had peaked at 20 percent, dropped below the national average of 19 percent all the way down to 6 percent. 

    Involving community members on the performance improvement team and other teams also helped engage the public as stakeholders in their collective health. PMC, like many other organizations, had no previous outreach to establish public accountability for:

    • Reducing health disparities
    • Improving quality of life
    • Increasing access to healthcare services

    Partnering outside the medical community made a big difference. We could tell our efforts were paying off when PMC experienced a 56 percent reduction in dental visits to the emergency department, making us the only medical center in Florida to realize any such reduction.

    Ultimately, the processes we initiated in pursuit of certification have helped us improve the health of our community while reducing the cost of care.


    Edwin Loftin is senior vice president, integrated and acute care, ands chief nursing officer, Parrish Medical Center, Titusville, Fla.

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