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  • 12 May 2013 8:20 AM | Anonymous

    What Will It Take to Ensure High Quality Transitional Care?
    Eric A. Coleman, MD, MPH
    Director, Care Transitions Program
    University of Colorado Denver

    1.       Foster Greater Engagement of Patients and Family Caregivers

    Greater engagement of patients and their family caregivers represents the centerpiece of any attempt to improve the quality of transitional care. To do so requires that we meet consumers where they are with respect to health literacy, cognition, and level of activation in order to provide customized care planning. Engagement includes encouraging patients to express their preferences and then honoring these preferences for type of services they desire, the intensity of health care services they receive, and the settings in which they receive them. Patients should not only have access to their care plan, they should have the opportunity to provide direct input. We recognize that transitions in health status are a key driver for transitions in care settings. It follows that in some instances, the best strategy may be to reduce or minimize the number of care transitions.

    2. Elevate the Status of Family Caregivers as Essential Members of the Care Team

     

    Closely related to honoring the preferences of older adults is the importance of recognizing the valuable contributions made by family caregivers. Family caregivers are the unsung heroes of transitional care and yet their valuable contributions often go unrecognized or taken for granted. We simply cannot afford to ignore or avoid the very same individuals that we implicitly rely upon to execute the care plan, monitor for threats to patient safety, and serve as de facto care coordinators. Family caregivers deserve our respect and by necessity need to be treated as full-fledged members of our interdisciplinary teams with direct input into the development of the care plan. Building the capacity for greater engagement of family caregivers represents an immediate solution and perhaps our best investment for the future.

    3. Implement Performance Measurement

     

    The lack of quality measurement of transitional care represents a significant barrier to improving quality and safety. With few exceptions, quality is not routinely measured. In contrast to all that we have learned in applying the principles of “Lean Thinking” to health care, all too often we do not explicitly reach out to our “customers” [patients] for their input as to whether the services we provide add value. Thus an important quality improvement strategy incorporates the patient’s voice in performance measurement and paves the way for establishing accountability.

    4. Define Accountability During Transitions

     

    Patients making transitions across care settings need to understand who is the accountable professional overseeing their care at all times. As articulated in by the Transitions of Care Consensus Policy Statement [a coalition representing six physician professional societies], the sending care team should maintain responsibility for the care of the patient until the receiving care team has had the opportunity to review the goals for care and the accompanying transfer information, clarify any outstanding questions, and acknowledge assumption of responsibility.

    5. Build Professional Competency in Care Coordination

     

    Most health care professionals had little exposure to strategies that promote effective care coordination. Transition-specific core competencies for health care professionals encompass more than the mechanics for facilitating cross-setting communication and collaboration, it also requires an appreciation for the differences in culture and care delivery capacity needed to ensure an ideal match between a patient’s care needs and his or her care setting. Training should also include how to meet patients at their level in order to prepare them to self-manage their acute and chronic conditions and understand how to get their needs met during care transitions.

    6. Explore Technological Solutions to Improve Cross Setting Communication

     

    Cross setting communication represents a central core competency. We need to establish standard operating procedures for the content, timeliness, and mode of health information exchange. Health care is woefully behind other industries with respect to the use of technological solutions for ensuring that our “product” is reliably delivered with high quality and safety. There are many new opportunities for widespread adoption of existing and emerging technology into the arena of transitional care. Federal guidelines aimed at promoting the meaningful use of health information technology represent a significant step forward in this regard.

    7. Align Financial Incentives to Promote Cross Setting Collaboration

     

    Transitional care further exposes one of the greatest weaknesses of our health care delivery systemundefinednamely that it is not in fact a system. Thus potential solutions will also require efforts to promote greater “systemness” to an otherwise fragmented delivery model. There are an increasing array of opportunities to create synergy between efforts to improve transitional care and newly introduced complementary approaches aimed at bending the cost curve. The CMS Community Care Transitions Program, patient-centered medical home, the President’s hospital patient safety initiative, bundled payment, and accountable care organizations all provide opportunities to align financial incentives toward promoting greater cross setting coordination and collaboration.

    http://www.caretransitions.org/What_will_it_take.asp

  • 12 May 2013 8:13 AM | Anonymous

     "We define care coordination as the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care."

    Five key elements comprising care coordination:

    1.

    Numerous participants are typically involved in care coordination;

    2.

    Coordination is necessary when participants are dependent upon each other to carry out disparate activities in a patient's care;

    3.

    In order to carry out these activities in a coordinated way, each participant needs adequate knowledge about their own and others' roles, and available resources;

    4.

    In order to manage all required patient care activities, participants rely on exchange of information; and

    5.

    Integration of care activities has the goal of facilitating appropriate delivery of health care services.

    Source:  http://www.ncbi.nlm.nih.gov/books/NBK44012/#A25381

  • 04 May 2013 3:00 PM | Anonymous

    Most of us like to think of ourselves as good to excellent communicators. However, if we were to survey our patients about our communication skills, we would find, to our dismay, that we are deficient in our ability to receive and transmit information to our patients.

    A study that monitored provider-patient interactions found that most healthcare providers will interrupt a patient only sixteen seconds after the patient starts talking. You can expect in the near future that healthcare providers are going to be compensated according to their communications skills. Many pay for performance (P4P) programs will base their compensation at least in part on patient satisfaction, which is highly dependent upon provider communication skills.

    This article will provide nine suggestions that will enhance your communications and thus enhance your patient's experience with you and your business.

    1.  The first interaction with the patient.
    Many of us would start the patient interview with "What brings you to the office today?" or "Why did Doctor X refer you to our office?" What you see as efficiency and professionalism, the patient may perceive as "He's obviously in a hurry; he's not interested in me as a person, only as a medical record."

    To avoid this inaccurate perception, we suggest that the first two minutes of the new patient interview be devoted to non-medical questions. Examples include "What kind of work do you do?" "Where do you work?" "How long have you been retired?" "Where do you live?" Usually one of these questions will lead to additional talking points that make the patient feel you are interested in them as a person and not as an organ system.

    2.  Ice breakers to use for established patients.
    For returning patients, we suggest that the first thirty seconds be dedicated to a non-medical discussion. "How was your vacation?" "How are your children?" are examples of non-medical ice-breakers that allow patients to believe you are as interested in them as you are about their symptoms.

    3.  Ending the patient encounter.
    Many of us, particularly those of us in medical practices, end the interaction by giving the patient a prescription, handing them their chart with the superbill and handing them off to the nurse or receptionist so that they can make their next appointment. This method can lead to the "door knob" question which occurs the moment you place your hand on the door knob and the patient tells you that they have one more question that they would like to ask.

    You can avoid this scenario by asking every patient "Have I answered all of your questions?" or "Is there anything we haven't covered that you would like to discuss on your visit today?" Ending each encounter with these kinds of questions assures you that patients are satisfied with their encounter with you and the practice.

    4.  Communicate with patients at the same eye level.
    Effective communication is difficult if you are standing up and the patient is seated. Standing while the patient remains seated puts you in a dominating position. As a result, even though it seems like a subtle distinction, your patient may fee uncomfortable or non-receptive if you are not at the same eye level. Avoid patient discomfort by sitting when the patient is sitting and making every effort to remain at the same eye level as your patient.

    5.  Talk to your patients when they are fully clothed.
    Most patients feel uncomfortable and exposed when a healthcare provider talks with them while they are wearing only a patient gown. Patients hear you better when they are not having a simultaneous internal self-talk conversation about how they wish they could put their clothes back on.

    Therefore, we suggest allowing all patients to get dressed before you return to the exam room for a discussion of their problem, your findings, and your recommendations.

    6.  Avoid barriers.
    If you speak to a patient in a office  avoid a conversation with you on one side of a desk and the patient on the other. Ideally, both you and your patient can sit on the same side of the desk or if you are in the exam room, have your discussion without barriers between you and your patient.

    7.  Empower your patients.
    If your patient needs to have blood drawn, the patient should be asked which arm they would like to use for the blood draw. Many patients know which arm has a better vein from their previous experiences. Regardless, many patients may have a preference of which arm they want to use. Even simple courtesies empower your patients, which enhances your communication and their perception of your practice. Always remember that the experience your patient has with your staff affects their overall perception of your practice.

    8.  Provide useful educational materials to patients.
    There's no better way to increase your communication with patients than to make sure that they have access to credible, current educational material on their condition. In addition to your office pamphlets, you can provide helpful educational information on your website and can refer patients to that information when they call with questions or issues but are not in your office.

    Information is empowering, particularly on subjects that directly affect or concern us. Patient who are more knowledgeable about their condition are likely to better understand your recommended treatment options at the time of the patient's visit. You should also provide additional information to the patient after their visit. This can include educational information on prescribed medications or educational materials regarding any procedure you are going to do on the patient. Remember, an educated patient is a better and more compliant patient.

    9.  Communicate with the patient's family, caregiver, spouse, or children.
    We often talk to our patients only to receive a call from a caring and concerned family member who asks questions that were covered in a discussion with the patient. However, the patient was so distracted during their office visit that they didn't remember the conversation. This is quite common with patients who receive a diagnosis of serious illness. This news is often such a shock that they shut down and don't hear or remember our advice and recommendations.

    In situations that may inspire lots of questions from family members or caregivers of the patient, and particularly if you believe that the patient will not be able to recall the information later, you should ask the patient if they would like to include a spouse or other family member in the conversation. You can also provide the patient with a short written summary of your verbal discussion. This process improves your communication and your relationship with the patient and the patient's family.

    Dr. Neil Baum is a physician in New Orleans, Louisiana and the author of "Marketing Your Clinical Practice-Ethically, Effectively, and Economically." www.neilbaum.com

  • 18 Apr 2013 11:55 AM | Anonymous

    Click here:  Free CEU Presentation

    SouthernCare is providing a pain management in-service on May 9th at the Hilton Garden Inn at I-65 and County Line Road. It includes 6 hours of CEUs. Above is a link to their flier with more detailed information. SouthernCare is certified with the ANCC, NASW, and NAB. Please feel free to RSVP directly to me or by calling our office at 317-244-7160. Please feel free to share the flyer!

  • 17 Apr 2013 11:08 PM | Anonymous

    Earlier this year HHS Secretary Sebelius announced new information about the Health Insurance Marketplace on HealthCare.gov for families and small businesses. The Affordable Care Act creates unprecedented opportunities for millions of Americans to access health insurance coverage. The Health Insurance Marketplace also will offer important new health insurance options for small businesses and their employees.

    There are additional new resources now available on CMS.gov that may be particularly useful to you in these efforts. These materials and others to follow will help you and the people you serve understand the new Marketplaces better and learn more about how to help eligible individuals enroll in coverage. Here’s how you can get started:

    Understand the Landscape. You may be interested in reviewing Social Marketing Research for the Health Insurance Marketplace for background data on the nation’s uninsured.

     

    Educate your Community. Consider sharing materials available in the partner Resources Toolkit, such as brochures on the value of health insurance and the Health Insurance Marketplace, with your residents, patients, clients and neighbors. Encourage them to stay connected by:

    Spread the Word. To help increase awareness, consider posting a Healthcare.gov widget to your organization’s website, or re posting Healthcare.gov’s social media messages on Facebook and Twitter

  • 17 Apr 2013 4:48 PM | Anonymous
    Transitions in Care 2.0:

    Family Caregivers and Systems Change

    Tuesday, May 14, 2013
    8:30am - 4:00pm

    CUNY Graduate Center, 365 Fifth Avenue, New York City

    To register: http://uhfnyc.org/events/880892

     

    This full-day conference will examine in depth how to strengthen transitions in care programs by more effectively including family caregivers. A highlight will be the first presentation of the United Hospital Fund’s Action Agenda, “Transitions in Care 2.0.” Judith Feder, PhD, a member of the newly formed Commission on Long-Term Care, the conference keynoter, will discuss policy challenges in integrating family caregivers into medical care and long-term services and supports. Leaders of major national program modelsundefinedincluding Eric Coleman, MD, MPH, and Mary Naylor, PhD, RNundefinedwill discuss opportunities for and challenges in engaging family caregivers. A panel of family caregivers will discuss what would have made their experiences better, and participants will learn how they can begin to make change in their own institutions, drawing on experiences in New York and other states.

     

    Featured speakers:

    Keynote: “Framing the Policy Challenge”
    Judith Feder, PhD, Federal Commission on Long-Term Care;
    Georgetown Public Policy Institute, Georgetown University

     

    Transitions in Care 2.0: Action Agenda
    David A. Gould, PhD, United Hospital Fund

     

    Transitions and Family Caregiving
    Eric Coleman, MD, MPH, University of Colorado Anschutz Medical Campus
    Luke Hansen, MD, MHS, Feinberg School of Medicine,
    Northwestern University
    Mary D. Naylor, PhD, RN, University of Pennsylvania School of Nursing
    Jennifer L. Wolff, PhD, Johns Hopkins University, Bloomberg School
    of Public Health


    Caregivers Providing Complex Chronic Care
    Carol Levine, MA, United Hospital Fund
    Susan Reinhard, RN, PhD, AARP Public Policy Institute

    Family Caregivers: What Would Make Things Better?
    Jed Levine, Alzheimer’s Association–New York City Chapter
    Rev. Gregory L. Johnson, EmblemHealth
    Alix Kates Schulman, Author, To Love What Is
    Jasmine Jordan, Host, Caregiving and You

    Change You Can Make Tomorrow
    Peg M. Bradke, RN, MA, Institute for Healthcare Improvement,
    STAAR (State Action on Avoidable Rehospitalization Initiative)
    Carol Levine, MA, United Hospital Fund

  • 12 Apr 2013 8:49 AM | Anonymous

    The Indiana Caregiver Collaborative is an Indiana Continuity of Care Association initiative that is open to and comprised of organizations, health care providers, agencies, and professionals that work together to support the needs of informal/family caregivers.

    The group is currently working to define caregiver needs in our state and compile information about available caregiver resources to form a basis for our work together. The group welcomes other organizations that would like to increase their potential to impact the issue and access more resources for caregivers while working together to avoid duplication of services and increasing public awareness of resources. Please email us at indianacontinuityofcare@gmail.com if you are interested in learning more about the group.

  • 08 Apr 2013 7:56 AM | Anonymous
    Would you like to have presentations this May on Advance Directives, and the opportunity to get free Living Wills and Health Care Proxies for your clients?

    The Indiana State Bar Association is arranging for attorneys throughout our area to do this for your group for May, National Elder Law Month. This is the third year for this project.

    If you are interested in setting a date for this year, please let me know soon.
    Doug Germann
     574/291-0022 
    
    http://www.SouthBendElderCARINGlaw.com
    
  • 28 Mar 2013 10:07 AM | Anonymous
    By Melanie Evans
    Posted: March 25, 2013 - 6:30 pm ET

    How often patients land in the hospital and how long they stay better indicators of which patients would return to the hospital unnecessarily than types of illnesses, number of prescriptions and other factors, a study found.

    The results, published by JAMA Internal Medicine, are among the latest in a growing body of research that seeks to identify patients at high risk for avoidable hospital stays by shifting through patient data in search of flags that predict who will make a repeat hospital visit.

    Policymakers have targeted hospital readmissions as a source of potential waste. Last October, Medicare began to cut pay to hospitals with higher-than-expected readmissions within 30 days for heart attack, heart failure or pneumonia patients.

    Hospitals, too, have targeted readmissions in response to Medicare's push and in a bid to lower healthcare costs under new insurance contracts, such as accountable care, that include incentives to slow health spending.

    Dr. Jacques Donze, a research associate with the Brigham & Women's department of medicine who contributed to the study, said researchers sought to identify factors that could be tracked before patients leave the hospital so that clinicians might intervene with support that could prevent a repeat visit. A study already under way will use the score to identify patients to test potential interventions, such as individual coaching, home visits and pharmacist oversight of patients' medication, he said.

    The analysis used data for roughly 9,200 patients who stayed at Brigham and Women's Hospital for at least 24 hours between July 1, 2009, and June 30, 2010. Patients either did not return within 30 days to any of three Partners HealthCare hospitals, including Brigham and Women's, or were readmitted within a month for what was identified as an avoidable visit.

    Researchers with Brigham & Women's Hospital and the Bern University Hospital in Switzerland combed through two dozen patient characteristics that could be culled from patient records accessible during a hospital visit to look for potential risk factors.

    Of those characteristics which included factors such as age, whether patients had a caregiver upon leaving the hospital and certain laboratory results  the study identified eight that best predicted which patients would return to the hospital within a month.

    Ultimately, researchers used seven of the eight factors to create a risk score for potentially avoidable readmissions. The seven factors are hemoglobin at discharge; discharge from oncology; sodium level at discharge; number of procedures during first admission; non-elective versus elective admission; number of admissions within prior year and length of the hospital stay.

    Six medical conditions were examined as possible risk factors, and only congestive heart failure appeared to have any predictive value for readmissions. Congestive heart failure was eliminated from the risk score, however, because it was the weakest indicator and because the diagnosis in some cases doesn't materialize until billing data is generated after discharge.

    The score will be tested in an international study, which includes seven U.S. locations, said Dr. Jacques Donze, a research associate with the Brigham & Women's department of medicine who contributed to the study.

    Researchers said they believe that no prior studies have identified procedures during admission and sodium level at discharge as risk factors for readmissions. The number of hospital visits and length of stay, identified as important predictors, could be surrogates for other indicators that reflect the severity of patients' illness, the authors wrote.



    Read more: Study identifies patients at high risk for hospital readmissions | Modern Healthcare http://www.modernhealthcare.com/

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