Coordinated Care Still Needs Some Work

While coordinated care is widely considered the best way to keep costs down and provide better patient care and is a centerpiece of the Affordable Care Act, too often care coordination isn't really happening according to a story produced by Kaiser Health News in collaboration with the Washington Post.

Kaiser Health News quotes leading health policy analyst Lucian Leape: "nobody is responsible for coordinating care." According to the story, lack of coordination is resulting in an estimated 44,000 to 98,000 deaths from medical errors annually. This, despite health care's strong response to the landmark Institute of Medicine report, To Err Is Human, published in 1999. That study was the subject of an INQRI blog carnival in 2010, featuring posts from several INQRI-funded researchers.

There is good news, however -- an article HealthLeadersMedia, published earlier this week indicates that nurses have the skills and experience provide effective and successful coordinated care. According to sources in the article, nurses' experience at the bedside - caring for multiple patients and handling their varying needs - makes them uniquely suited to understand and provide coordinated care.

Several INQRI teams have investigated how nurses' contribute to improved care coordination, especially in times of transition from hospital to home.

RWJF Video Contest: Coordinating Care Transitions

Across the country, patients, their families, nurses, care coordinators, and other front-line health care providers are pioneering effective ways to reduce hospital readmissions. They are developing tools and practices to ensure that hospital staff, patients, and primary care providers are working together, especially when a patient’s care is transitioning, like when they leave the hospital for home or a nursing facility.

The Robert Wood Johnson Foundation (RWJF) is sponsoring a video contest to discover collaborative ways providers and patients are working to avoid readmissions and improve patients’ care and their health outcomes. Have you—as a patient, family member, caregiver, nurse, care coordinator, or other health care provider—developed an innovative approach to improve the way patients and their care teams communicate, especially when a patient is transitioning from the hospital?

Applying for the contest is simple. Just send a short video showing and/or telling what you are doing to improve transitions. Winners will then be professionally filmed, and they and their video will be featured during RWJF’s Care About Your Care effort early in 2013. Care About Your Care is a national effort to spark conversation and galvanize attention about what people can do to identify and receive better health care.

 Click here to learn more.

The Importance of Wellness In the Workplace

For those of you who follow the INQRI blog, you may be familiar with our coverage of issues addressing the health of the nursing workforce. Earlier this summer, a group of health care, human service, and education providers in Northeast Ohio created an innovative nursing initiative, which is currently undergoing rigorous external evaluation, to support health, satisfaction and the quality of care delivered by front-line nurses. Pamela A. Maidens, MA, CPM wrote a fantastic summary of how this initiative came about, why it is important, in addition to describing how the educational program works.

To read more about this wellness initiative, click here.

Free Webinar Highlighting Healthcare Transitions and Coordination

Next week, former INQRI grantee, Gerri Lamb, PhD, FAAN, RN, is the featured guest for a webinar focusing on how healthcare transitions and coordination affect early readmissions, care effectiveness and the economics associated with the two. This is the second webinar in this two part series that highlights the importance of care transitions.

To register for the upcoming webinar, click here.

To view the first webinar of the two part series, which featured INQRI director, Mary D. Naylor, PhD, RN, click here.

ANA: Care Coordination Should be Fully Funded

The American Nurses Association recently released a statement noting the importance of nurses in successful coordination of care delivered in hospitals.  They believe that fully funding these services will lead to improved health care quality and better patient outcomes.

Click here to read, "ANA: Care coordination should be reimbursed" on Nurse.com.

Click here to read about the Lamb-Sainfort INQRI project on care coordination.

Nurses, Care Coordinators Are Gaining Importance in ACOs

Earlier this morning, Jennifer Lubell, of AISHealth.com, detailed the growing importance of nurses in the ACO model of care. These "embedded nurses", or care coordinators, have been found to be an essential part of the ACO framework as they improve patient outcomes by providing a significant communication link between the patient and physician. Insurance companies, including Cigna and Aetna, have touted the care coordinator role as a key contributor to improved patient outcomes.

Click here to read the full article.

New Jersey Nurses Train to Coordinate Their Patients' Care

Last week, Beth Fitzgerald, reporting for NJ Spotlight, discussed how new nurses are learning a variety of skills to act as population care coordinators. The program, which is a collaborative effort between Horizon Healthcare Innovations (HHI), Duke University School of Nursing and Rutgers University College of Nursing, emphasizes the importance of new nurses taking on the roles of coach and health advocate in order to improve coordinated follow-up and preventive and wellness care. The program is also based off of the patient-centered medical home model of care and focuses on patient engagement to improve the overall quality of care.

Click here to read more about the new initiative.

Florida Hospitals, Nursing Homes Team Up To Cut High Readmission Rates

On Monday, Letitia Stein, of the St. Petersburg Times, detailed how Florida hospitals are collaborating with local rehabilitation and nursing facilities to prevent costly readmissions. With readmissions estimated to cost the US health care system an extra $4 billion, around half of which are preventable, Florida care providers are establishing initiatives to prevent readmissions and lower health expenditures. This month, several hospitals and nursing homes in Tampa Bay are testing out a new tool, a discharge form that seeks to put all health care providers on the same page.

Click here to read the full article and find out more information about new initiatives being undertaken at Florida hospitals.

Click here to read previous blogposts relating to reducing readmissions.

Click here to read previous blogposts discussing improvement efforts for care coordination.

Hospitals Utilize Visiting Nurse Practitioners To Lower 30-day Readmission Rates

Early this morning, Misty Williams, of the Atlanta Journal-Constitution, detailed how Atlanta area health systems are utilizing visiting nurse practitioners to improve care coordination, lower readmission rates, and as a result, reduce costs for the patient and hospital. With Medicare cuts that will reduce payments to hospitals with excessively high readmission rates scheduled for next year, hospitals are turning to visiting nurse services to ensure that patients are adhering to their medication and treatment regimens, as well as bridging the communication gap between hospital and patient that often results in a patient's readmission within 30-days of their hospital discharge.

Click here to read the full news article.

Click here to read similar blogposts discussing the importance of reducing readmissions.

INQRI Teams Featured in the Future of Nursing Report

As you saw on Monday, Linda Flynn's INQRI project was highlighted in the report from the Initiative on the Future of Nursing committee. We commend Flynn and her team on their wonderful contribution to the evidence base linking nursing to quality.

We also congratulate our two other INQRI teams who were featured in the committee's report:

As the coordination of care was highlighted as "one of the traditional strengths of the nursing profession," we were very pleased to see the inclusion of the work from Gerri Lamb and Francois Sainfort's INQRI project, "Nurse-Sensitive Measurement of Hospital Care Coordination." As the committee noted, their team "developed a Staff Nurse Care Coordination model that features six nurse care coordination activities regularly performed by staff nurses in hospital settings as part of their daily activities—mobilizing, exchanging, checking, organizing, assisting, and backfilling."

• Click here to learn about Gerri Lamb's work as the co-chair of the National Quality Forum's NQF’s Steering Committee on Care Coordination.

We also congratulate researchers at Johns Hopkins University, David Thompson, Jill Marsteller and J. Bryan Sexton for the inclusion of their findings from the INQRI study, "Linking Blood Stream Infection Rates to Intensive Care." As the committee noted, the team "found that substantial reductions in central line associated blood stream infections can be achieved with nurses leading the infection control effort. Hospitals that adopted [the team's] intensive care unit safety program as well as an environment that supported nurse’s involvement in quality improvement efforts reduced or eliminated bloodstream infections."

• Click here to read an article from the Baltimore Sun focused on Maryland hospitals that are joining Peter Pronovost's national effort (which includes the INQRI team members) to reduce infections.

NQF Endorses New Set of Practices and Quality Measures Supporting Care Coordination

To improve care for patients, reduce waste, and increase coordination within the fragmented U.S. healthcare system, the National Quality Forum has endorsed 10 performance measures and 25 preferred practices for care coordination. The endorsement is a step toward achieving the goals of the care coordination priority area set out by the National Priorities Partnership to transform healthcare.

“We must remember that patients and their families are the center of healthcare,” said Gerri Lamb, steering committee co-chair (and INQRI grantee). “Improving transitions, planning for discharge, and coordinating care across settings and providers means better care for patients and ultimately, a safer, higher quality healthcare system.”

Click here to read the press release.
Click here to download the measures.

How Nurses Coordinate Patient Care

When patients go to the hospital, they want their treatment to go as smoothly as possible, with everything happening at the expected time and they want up-to-date information about their care. Good care coordination in the hospital can affect how long a patient stays in the hospital, whether mistakes happen and whether the patient is prepared to go home and do well once out of the hospital and requires a lot of work by nurses behind the scenes. An INQRI team at Emory University has developed a tool to uncover and communicate the role staff nurses play in coordinating care for hospitalized patients. Through this research, the team has identified what care coordination activities nurses do and which are important for better care. Early tests of the tool have been promising, and show a link between nurse care coordination activities in the hospital and important patient outcomes. The team plans to refine the tool for the clinical setting to help nurses and discharge planners provide the highest quality care to patients. This research should lead to a better understanding of how to improve outcomes.

To learn about other INQRI teams making a positive effect on acute care, please click here.