Prevention program improves patient outcomes, saves money
Program attracts physician practice support
Thanks to a community health program that identifies health problems early on, hundreds of patients are being treated for chronic illnesses and other conditions before they need expensive interventions.
The Community Health Institute at Winchester Hospital in Woburn, MA launched its Putting Prevention into Practice Program as part of its efforts to invest more in community health.
"It’s the best health promotion we’ve ever done in terms of actual outcomes. By preventing complications later, it is helping shorten the period of disability that many people experience at the end of their life," says Kathleen Beyerman, RNC, EdD, director of the Community Health Institute.
The program is self-supporting because physicians pay a fee to have their patients screened. The program has been so successful that physicians realize a return on their investment in about three months, Beyerman says.
In addition to increased revenues from patients who might not otherwise come in for screenings or treatments, the physicians also have experienced an increase in patient satisfaction.
"This actually makes a person realize they have a health problem and they have an opportunity to do something about it," she says.
The program has been successful in the short term but Beyerman expects the long-term success to be even greater. "Patients can have hypertension treated as opposed to a stroke. We are discovering their diabetes before they have retinopathy. Instead of having a MI at 50, they may have it at 80," she adds.
Here’s how the program works. If a physician practice is interested in participating, it gives the program a space big enough for a chart and a laptop computer and access to the records. The physician practice pays for the service on a per-chart basis.
A prevention specialist, a registered nurse from the Community Health Institute, goes to the office, goes through the charts one-by-one, and enters the information into the computer. The specially created software identifies patients who are at risk for hypertension, diabetes, cancer, and high cholesterol and creates a prevention plan for each patient, customized to gender, age, and risk factors. The computer generates a letter to the patient, suggesting that they come in for tests relative to their at-risk issues. The risk factors are based on family history, and other factors such as age, gender, and weight.
For instance, if a patient is not at risk for diabetes, he will be instructed to come in for a blood sugar screening every five years. Patients who are at risk are asked to come in annually.
If the patient doesn’t call for an appointment within two weeks of the suggested time, the physician office evening staff follows up by telephone.
The program generates two copies of the prevention plan—one for the patient record and one for the patient to receive during his or her next visit.
"Patients go home knowing when they are due for what test," Beyerman says.
So far, two staff members have enrolled about 50,000 patients of 18 clinicians.
Getting the data from the charts is a labor-intensive process. Since most physicians still use paper records, the nurse has to extract the data manually. "That’s why we use RNs. They know how to navigate a record and can read the handwriting," Beyerman says.
The Community Health Institute is involved only to the extent of sending the letter that connects the patients with their doctor. The physician takes it from there. "We do provide the physician with resources if they have a patient who needs something like diabetes teaching," Beyerman says.
Local physicians cover most of the cost of the program by paying on a chart-by-chart basis to have their patients screened
"The doctors have found it is a tremendous marketing tool. It doesn’t bring in new patients, but existing patients really appreciated getting a letter from their doctor. There was a lot of bonding that took place," she says.
As a result some practices are so much busier that they’ve been able to bring in other clinicians and build the practice, Beyerman adds. For instance, one practice of two family practice doctors has added three additional doctors and a nurse practitioner. Beyerman asked the practice manager if it was because the doctors were exceptionally good. She was told, "It’s because of putting prevention into practice."
There were other unexpected benefits. Because Woburn is close to Boston and is a college community, many patients are transient. The doctors felt it was beneficial to find out whether patients had moved away, in which case it would no longer be necessary to keep the chart on file.
Beyerman’s staff started out by conducting an assessment of the community to find out where the health problems were. "We extrapolated some numbing information from the American Diabetes Association data—that there were 17,000 case of undiagnosed diabetes in our community, Beyerman says. That inspired their first project—finding the undiagnosed diabetes cases in their community of 350,000.
"As a nurse, I realized the implications. It’s hard enough for people who know they have diabetes to maintain a good blood sugar," Beyerman says.
The hospital created a diabetes case-finding software program. Registered nurses from the Community Health Institute went to physician practices with a laptop computer and screened the patient records for people who had risk factors for diabetes.
The program generated a letter from the physician asking them to come into the office for a blood sugar test.
The nurses found that each time they went into a practice, the physicians asked them to do something in addition to the diabetes risk screening. For instance, because diabetics have a greater chance of elevated cholesterol, they wanted the letter to suggest cholesterol screening.
"We started looking at why we were limiting ourselves," Beyerman says.
It was about that time that Beyerman’s dog got a reminder from its veterinarian about heartworm testing.
"I wondered why the doctor wasn’t calling me. We realized this was an opportunity to do early detection for more than just diabetes and cholesterol and moved forward to expand our program," she says.
The screening program includes factors for high risk, intervals for screening high risk patients, intervals for screening other patients, and standards used in determining the risks and intervals.
Five tips for starting a health screening program in your community
- Get a handle on your medical staff to know where to start. The first physicians approached should be those who are interested in growth. It’s a hard sell for physicians who are getting ready to retire unless they have brought on a new physician.
- Use a registered nurse to get the data from the physician’s charts. They are experienced in reading charts—and physician handwriting.
- Offer a maintenance arrangement with the physicians after you have enrolled all the existing patients. Winchester Hospital’s Putting Prevention into Practice program sends the prevention specialist back once a month to produce letters and enroll any new patients that have come into the practice.
- Don’t try to do everything at once. Start with a few practices and increase slowly.
- Don’t create customer service problems for the physicians. Enroll several practices gradually so the physicians won’t be inundated by patients that they aren’t able to see, or who won’t be able to get through on the telephone.
Winchester Hospital’s Community Health Institute will license its Putting Prevention into Practice software program to other health care organizations. For more information contact Kathleen Beyerman (781) 756-4713 e-mail: [email protected].
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