Award-winning disease management program yields big results
Get lower costs, fewer readmits, and great PR all in one package
Editor’s Note: In February, the American Hospital Association (AHA) of Washington, DC, presented five hospitals with its NOVA award, honoring their "innovative, collaborative projects designed to improve the health status of their communities." Over the next several months, Patient-Focused Care and Satisfaction will look at the winning organizations and the programs they created which so impressed the AHA.
It’s the kind of program that any hospital would love to have. For a minimal investment, you not only cut costs per case for complex diagnoses, but you reduce hospital readmissions, build community good will, foster an improved continuum of care, and have a program you can take to managed care organizations as a basis for negotiating contracts. On top of that, the AHA gives you an award for your effort.
That’s just the kind of program Middletown (OH) Regional Hospital developed two years ago for patients with chronic illnesses. Provided at no cost to patients or their insurers, the project offers patients education, disease management skills, coordination of care, and the services of patient advocates 24 hours a day, seven days a week.
Carol Turner, FACHE, vice president of clinical and information services at the 310-bed not-for-profit community hospital, says the project came after a local task force found that many chronically ill patients did not have the resources or knowledge to adequately manage their diseases. As a result, patients often came to the hospital’s emergency department rather than seek care from their primary care physicians.
Indeed, a Greater Dayton Area Hospital Council study shows some 8,000 people in the area listed urgent care facilities and the emergency department at local hospitals as their customary source of health care. And the hospital’s rate of readmission for patients previously discharged had almost doubled between 1995 and 1996.
Two years after the program began, hospital admissions for those patients had decreased 56%; the average length of stay for those hospitalized decreased 17% to 4.9 days; and the average charge per case dropped almost $9,000.
"This was a way for the community to work together to improve health status among our citizens," Turner explains. "We worked with hospices, parish nurses, home care agencies, and other health care providers to make sure that patients could move through a seamless system."
The project involved 15 community leaders in the beginning, but expanded to community forums of more than 250 people. "We wanted to establish a community-based case management program, but we wanted it to be management in all areas where patients receive care, not just one episode of care." That meant providing education, coordination of care, and advocacy services.
The resulting program includes the following features:
It does not require physician referrals.It is not dependent on Medicare guidelines.
It is a free service to the patient.
The patient must agree to case management services.
It provides managers 24 hours a day, seven days a week to patients.
It provides case managers for referral to resources such as home care, hospice, nursing home placement, DME, support groups, etc.
The case managers act as patient advocates.
The case managers promote appropriate use of resources.
Outreach equals success
By 1997, the hospital had hired a full-time nurse case manager for the program, at a cost of about $100,000. "We chose to recruit critical care nurses because we felt they had the best skills," says Turner. With that initial hire, the program began to admit patients, and as the patient base grew, positions were added. There are now two case managers, and a third will be added this spring to fulfill the needs of the patients in the program.
Not every patient is a candidate. "A 30-year-old appendectomy patient doesn’t need this," Turner says. "But if you have multiple co-morbid conditions, multiple medications, and no help at home, we can demonstrate to our payers that this is an effective program."
To help determine who is the best candidate for the program — and there have been 180 participants so far — there is a complex assessment tool (for more on patient acceptance, see box, above). Patients are reassessed at 30 days, 120 days, and when they are discharged from the program.
There were specific financial and clinical goals for the program. Financial goals were outlined in a business plan that was presented to the hospital executive committee, says Turner. The committee members were an easy sell, in part because they understood that costs associated with emergent care and hospital readmissions can be so high for hospitals.
Clinically, the project looked at outcomes using a behavioral-based problem rating scale. The five-point scale looks at knowledge, health status, correct use of medication, compliance, understanding of issues such as diet, and activities of daily living.
"This is data we can take out when we negotiate managed care contracts," Turner says. "We can show them how effectively we can manage our patients."
The program is marketed among the hospital’s medical staff, discharge planners, and other health care providers in the area. Adult protective services is also aware of the program. There was some initial press coverage of the program, and after the NOVA award from the AHA, still more media interest.
Turner thinks hospitals that have good information on patient demographics and an identified problem with readmissions and emergent care use could probably benefit from a program like this. "But you need to know that you need it, and the kinds of patients who need it to make it work. If you are in an area where congestive heart failure is a big issue, then the program needs to be tailored to meet those needs."
Initially, Turner opened up the program to all diagnoses. "If we had it to do over, we wouldn’t do that," she admits. "We would focus on things like CHF or cardiomyopathy. We have had to develop expertise and clinical pathways and decision-making abilities for some very complex diseases."
Overall, Turner rates the program a huge success. "It is a great fit with our patients; it demonstrates community outreach, and it builds a lot of rapport with the patient group. From a PR and marketing perspective, it’s a great thing. These people are loyal to our system. When you are competing for patients, this is a customer service opportunity, and a way to demonstrate your community involvement and your mission to improve the health status of the community and your ability to take care of sick people."
Source
• Carol Turner, FACHE, Vice President, Clinical and Information Services, 105 McKnight Drive, Middletown, OH, 45044. Telephone: (513) 420-5112.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content