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Tag Archives: hospitalizations

HCUP: Potentially Preventable Pediatric Inpatient Stays for Asthma and Diabetes

A statistical brief from the Healthcare Cost and Utilization Project (HCUP) addresses one of the key issues in the healthcare industry today: preventing hospitalizations. HCUP examined trends in the rates of potentially preventable pediatric visits for asthma and diabetes, which have increased by 21 percent in recent years after seven years of decline.

Linda Barlow

Linda Barlow

Potentially preventable pediatric stays were more common for asthma than for diabetes, with asthma-related stays occurring at over four times the rate of diabetes-related stays. According to HCUP, asthma and diabetes remain more common in certain racial and ethnic minority groups and among poor and underserved populations.  Many hospital stays are potentially avoidable through regular ambulatory care by specialty and primary care physicians. Efforts to improve clinical guidelines and establish medical homes, as well as other initiatives may also result in a decline in potentially preventable pediatric hospital stays, according to the brief.

What strategies can patients and caregivers pursue to help reduce the rate of preventable hospital stays for children suffering from asthma and diabetes? Let us know your ideas in the comments section.

Personal Connections with Pharmacists Drive Medication Adherence Outcomes

With nearly half of all patients in the US not taking their medications as prescribed, medication non-adherence remains a dangerous and expensive problem that costs the health care system $329 billion annually (Express Scripts Drug Trend Report), meaning more hospitalizations and visits to the emergency room (ER).

Paul DeMiglio

Paul DeMiglio

So what’s the good news? Effective, comprehensive solutions are emerging to reverse this trend by involving the pharmacist to improve medication adherence rates through a personal connection with patients.

Recent stories underscore how pharmacists are uniquely positioned to engage patients in conversations that help them understand why treatments are prescribed and why meds should be taken as directed.

A report released on June 25 by the National Community Pharmacists Association (NCPA), for example, illustrates how interpersonal relationships between pharmacists and patients boost adherence. Authors of the report found that a patient’s sense of connectedness with one’s pharmacist or pharmacy staff was the survey’s “single strongest individual predictor of medication adherence.”

“Pharmacists can help patients and caregivers overcome barriers to effectively and consistently follow medication regimens,” NCPA CEO B. Douglas Hoey, RPh, MBA, said in a statement. “Indeed, independent community pharmacists in particular may be well-suited to boost patient adherence given their close connection with patients and their caregivers.”

According to the American Pharmacists Association (APhA), one effective method pharmacists can use to improve adherence is medication therapy management (MTM) services for patients taking more than one drug for multiple chronic medical conditions. In addition to therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and other clinical services, MTM involves the following elements:

  • Comprehensive medication review, including a personal medication report that lists all the medications the patient is taking.
  • Medication action plan.
  • Education and counseling or other resources to enhance understanding about using the medication and to improve adherence.
  • Coordination of care, including documenting MTM services, providing the documentation to other providers, and referring patients to other providers as needed.

Pharmacists can also leverage a variety of practical tips to help patients improve adherence that include:

  • Discussing the appropriateness of each medication and its impact on their multiple medical conditions.
  • Evaluating the effectiveness and safety of each medication.
  • Assessing whether some medications may be unnecessary and should be discontinued.
  • Discussing the need to change medications or doses if problems arise.

The implications of improved adherence will help lower the cost of treating chronic conditions, decrease hospitalizations, reduce ER visits and by extension lower the risk of treatment failures, serious adverse reactions and deaths too.

“Studies have repeatedly recorded the cost-saving effect of MTM,” said Kevin Schweers, Senior Vice President, Public Affairs, NCPA. “One Minnesota study found a 12:1 return-on-investment for MTM.  In North Carolina, Kerr Drug reports that MTM programs for seniors produced a 13:1 return. Improved adherence would likely help reduce hospitalizations as well. So many prescription drugs are intended to treat chronic conditions, such as heart disease, that can result in hospitalization. In addition, hospital re-admissions can result from the failure to stick to a prescribed medication regimen.”

Joel Zive, adjunct clinical faculty, University of Florida College of Pharmacy, underscored the need for patients to cultivate relationships with their pharmacists.

“While MTM services are quite important in helping adherence, getting to know your pharmacist’s name is helpful in establishing a relationship with your pharmacist,” he said. “Pharmacists are trained to pick up clinical clues from patients.  This is why if you are having unusual reactions medications, speaking to your pharmacist is an option.”

Although MTM services are an effective way to increase adherence, greater participation among patients and pharmacists is needed according to the APhA and the National Council on Patient Information and Education (NCPIE).

In addition to leveraging tips and strategies to boost adherence, pharmacists can also draw on a number of resources for patients, referring them to the NCPIE wallet card and to a brochure made available by NCPIE and the Agency for Healthcare Research and Quality (AHRQ), “Your Medicine: Be Smart. Be Safe.”

What else can pharmacists do to engage patients? How can stakeholders in health care, government, academia and the private sector collaborate to improve dialogue among pharmacists and patients around strategies that increase adherence?

Cleveland Clinic’s Value-Based Care Team Improves Patient Wait Times, Saves Costs

Cleveland Clinic CEO and President Toby Cosgrove, MD, believes that the medical center is ready to “lead the charge” in delivering better patient outcomes and faster care, all at a lower cost.

Dr. Toby Cosgrove

Toby Cosgrove, MD

To that end, the Cleveland Clinic has established a Value-Based Care Team, made up of physicians, nurses and other experts who will work together to translate “better, lower cost and faster” into everyday practice. Services are rationalized across the network, with multi-specialty teams using system-wide resources to deliver the right care at the right place for every patient, at the right time with the right cost.

“Value is the centerpiece of Cleveland Clinic’s strategy,” said Associate Chief of Staff for Clinical Integration Development, Dr. David Longworth, who heads the Clinic’s Value-Based Care Steering Committee. “We are focused on two areas. One is to eliminate unnecessary practice variation by developing evidence-based care paths across diseases. The other is comprehensive care coordination to allow patients to move seamlessly through the system so that we reduce unnecessary hospitalizations and ER visits.”

According to Dr. Longworth, the TeamCare model helps to:

  • Increase throughput.
  • Reduce the cost-per-unit of service.
  • Improve patient and provider satisfaction.

“In the past, each physician had one medical assistant who simply roomed the patient and took vitals,” he explained. “All the chart work was done by the physician, often at home in the evenings, adding several hours of work to their day and extra time to the entire process. Now, physicians go home at the end of the day with all their charts closed.”

The TeamCare model helps the Cleveland Clinic improve its Patient Experience ratings in a number of measured metrics, including:

  • 22.8 percent improvement in wait time at clinic.
  • 10.7 percent improvement in wait time in exam room to see provider.
  • 8.9 percent improvement in the time the provider spent with the patient.

While the Value-Based Care Team may be a concept borne of the new world of health care, the Cleveland Clinic has a rich history of improving patient outcomes. In 2000, the Clinic became the first hospital in the U.S. to publish its outcome measures and now publishes outcome books for every department, comparing itself to the best available benchmarks.

The Cleveland Clinic further changed the way it delivers care by developing Institutes to house medical and surgical specialties, working under one Institute leader and one budget. In some Institutes, inpatient and outpatient care are co-located, and Institute leadership is charged with defining what diseases and conditions each Institute cares for, developing a set of shared outcome measures for which the team is jointly accountable. Leaders also identify the skills that need to be brought together to care for patients with the sets of conditions the team treats.

Institutes are given autonomy to pursue different implementation approaches and are expected to share insights with others. For example, the Neurological Institute created a website so that others at the Clinic could learn how it was developing performance measures and decide whether to use a similar approach.

In the case of a primary care pilot program, Value-Based Care relies on a team approach that leads to a higher-efficiency practice style. Responsibilities are shared among two medical assistants and the physician, with each individual functioning to the highest level of their scope.

For each patient visit, a medical assistant brings the patient to a treatment room and obtains vitals and additional medical history information, which they immediately enter into the patient’s electronic medical record. The medical assistant remains in the room during the examination, acting as a real-time transcriber for the doctor’s notes and orders, which are also sent immediately to the physician’s inbox for verification and signature so the assistant can schedule any follow-up tests or procedures before the appointment is complete. At the same time, the physician’s second medical assistant is getting the doctor’s next patient set up in another treatment room.

Value-Based Care also helps the Clinic reduce costs. In fact, in just under a year, the direct cost per patient encounter dropped by 7.5 percent while the number of patient encounters per day increased by 16.4 percent.

The hospital lowers costs in other ways as well, such as avoiding 12,082 lab tests in 2011 and 2012 for a savings of $1.2 million and lowering the cost of lung transplant surgery by 11 percent. Cleveland Clinic also is getting patients into treatment faster, with the total number of same-day visits increasing by 14 percent and the average emergency room door-to-doctor time reduced to 17 minutes.

These strides are helping Cleveland Clinic reach the Top 20 of the University HealthSystem Consortium’s (UHC) quality index, earning UHC’s Rising Star award by improving inpatient centeredness, mortality, equity, efficiency, effectiveness and safety.

The Cleveland Clinic model is a good example of how health systems can develop evidence-based models to generate higher quality care at a lower cost. What are other hospitals and health systems doing to redesign care delivery paths? Let us know what’s working.

Categories: Cost-Savings