There’s good news in the long difficult area of hospital readmissions, particularly those involving older patients supported by Medicare.
A pivotal study published in the Journal of the American Medical Association (JAMA) found such readmissions have declined twice as much in communities which enlisted the leadership of a Quality Improvement Organization (QIO).
The study provides validation for efforts by Rocky Hill-based Qualidigm, the Medicare QIO contractor for the state of Connecticut. The firm has followed the national QIO model by engaging the healthcare community to collaborate on improvement initiatives. Qualidigm’s cross-communicative program, Communities of Care, began in 2010 and now has more than 200 participating organizations, including hospitals, nursing homes, home health agencies, hospice agencies, specialty-care practices, and physician practices.
“Communities of Care is all about being a neutral convener, bringing stakeholders together to improve communications across the continuum,” says Tom Meehan, chief medical officer for Qualidigm. “We bring together different entities to gather data so that we can answer questions. Who is coming back, and why? What systems are in place to reconcile a patient’s medications as they move from one place to another? It’s about knowing who is responsible as a patient traverses the healthcare system.”
The approach seems to be working. Over the past three years, Qualidigm leaders are estimating the cost savings associated with avoiding preventable hospitalizations for relevant Medicare patients to be approximately $5.4 million in the state of Connecticut.
“We are able to facilitate change by providing individual technical support for specific initiatives, while fostering a collaborative environment in which these organizations can share partnership assessments, patient data, and experience; one community may be facing an issue another community has already addressed, and they can talk about that,” says Dr. Meehan. “It’s a volunteer effort which has really been embraced. I’ve ever seen the healthcare community this excited and engaged across the continuum.”
Some on the front lines, however, still question the effectiveness of the QIO model. Sharon Gauthier sees the issue from a variety of perspectives — as a registered nurse, independent patient advocate and owner of A Patient Advocate for You. She says she sees Medicare patients struggling with care continuum blockades on a daily basis.
“I recently had a patient transferred from the hospital to go home on a Friday as a one-person assist. I had spoken to the nurses about making sure she had all four of her meds, including those she had been taking regularly for pain,” she says.
Over the course of 10 hours on her discharge day, Gauthier says, her patient was delayed due to administrative and transportation issues and eventually arrived home with only two of her necessary medications, neither of which were for her pain. The woman’s in-home support was also delayed when her referral was lost; it was found quickly, but was incorrectly dated by one week.
“Without family or an advocate, that patient would have panicked, been in pain, called 9-1-1, and been readmitted,” she says. “It’s a perfect example of what happens when no one talks to each other or the patient. In this case, the clinical care she received was excellent — it was the service that wasn’t good.”
With 70 percent of her caseload representing seniors on Medicare, Gauthier says these stories remain common in her world, leading her to question the QIO success rates being reported.
“I’m not sure I trust this information. They are self-reporting and self-monitoring; of course there are good stories,” she says. “I’ve had patients who have been held under observation for days without being technically admitted; that can also lower readmission rates.”
In response to healthcare professionals like Gauthier who aren’t yet seeing the tangible change from broader initiatives, Qualidigm CEO Tim Elwell says the answer is active inclusion.
“Of the 40 organizations which make up the Qualidigm Connecticut Partners for Health Program, 14 are advocacy based. The challenges identified by that group are what Communities of Care is aimed at addressing. It really is a grass roots effort, and we want that input,” he says, adding that family members and individuals are welcome to join the conversation as well. “This is why we are also working to develop programs which engage not just the healthcare community, but anyone with an interest in the process.”
One of those efforts is the Better Health: Everyone’s Responsibility conference, scheduled for Sept. 17 at the Connecticut Convention Center in Hartford. A first of its kind, the educational event will include programming for healthcare providers as well as consumers; anyone who has an interest in improving effective communication and health self-management is welcome.
“Our goal is to make connections between care providers, and then extend that collaboration to consumers so that we can answer their questions as well,” Elwell says. “In addition to our ever expanding Communities of Care, our conference attendees will gain the knowledge needed to help us get the word out as to what a QIO is all about. Together, we can all work to improve the success of the program.”
