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Engaging the Chronic Care Patient

Joe Cantlupe, for HealthLeaders Media, November 27, 2013

Carolina Health Alliance also relies on an electronic medical system that gives its physician an accurate real-time view of patients' conditions. The system checks on the current status of patients using a color-based system. For instance, diabetics' color coding might be graduated by intensity of need with red, yellow, or green defining the severity of their current condition.

On-site lab testing is available and on-site pharmacists work with patients to review medication. The practice also uses smartphone and Web-based programs that allow patients to monitor their diabetes, so "we are engaged, not intrusive," he says.

As they evaluate patients' chronic conditions, Carolina Health Alliance looks at patient psychological and social conditions as effects on their care. It doesn't stop at the doorstep of clinical needs. "With our patient connect surveys, in the comfort of their own home, they can respond to screenings for depression, tobacco and alcohol abuse, and domestic violence," Warcup says.

Flexibility in hours also figures prominently in patient satisfaction. The medical offices open at 7 a.m., stay open at lunchtime, and include two nights with evening hours and half days on Saturdays. Appointments can be scheduled within 48 hours.

Overall, Warcup says that the "patient has a real appetite to understand why we do the things we do." And the message to patients is: "Ultimately, it's your decision and what we do is based on your goals."

Success key No. 2: Constant reminders

Usually, patients are given instructions about medication and taking care of themselves as reminders before being discharged from hospitals. The 174-bed Florida Hospital Celebration Health in Celebration, Fla., doesn't just ask questions or give reminders to patients when they are leaving.

At FHCH, the scenario seems more proactive: Patients are given reminders about their follow-up care while they are still in the hospital, days before discharge. The reminders are shared with friends and family members, too, with the approval of the patients. The staff asks patients questions about areas related to the Hospital Consumer Assessment of Healthcare Providers and Systems.

It is important that discharge planning begins early, says Monica Reed, MD, CEO of FHCH, which is part of Florida Hospital, a system that includes eight campuses serving the greater Orlando area. Nurses work with patients days before discharge to go over their care plans, medications, and what's needed for follow-up care, Reed says. Too often, "patients don't know what their medical diagnosis is, they don't understand the medication they are using, they don't make it to the next doctor's appointment after discharge. And then they end up back in the hospital with the same problem," Reed says.

The hospital ensures that patients receive educational plans gradually, says Patty Jo Toor, RN, OCN, MSN, the chief nursing officer for FHCH. "We want to be sure that patients aren't bombarded," she says. Hospital officials want the patient to have enough educational material to begin taking control of their care. Heart failure patients, for instance, are taught generally about the disease and what it means for them personally: the foods they should eat, what kind of exercise program they should have, Toor adds. To help patients understand their medications, nurses explain the prescription regimen and give them proper dosage before discharge.

The hospital tracked HCAHPS scores between 2012 and 2013. Nurse communication increased 13%, up from 70% to 79%; communication about medication increased 8%, from 59% to 64%; and discharge information scores increased 6%, from 79% to 84%. The overall rating improved 5%, up from 73% to 77%, and willingness to recommend jumped 16%, from 69% to 80%.

For CEO Reed, patient satisfaction stems from having patients engaged in their own care. "I think patient satisfaction is the beginning, then you have activation for the patient.

"At the end of the day," Reed adds, "you want to keep patients out of the hospital. So we want them to understand their disease process and to trust their care providers to help them in their disease process. I think loyalty is a substitute for trust: Do I trust these people with my health? If patients know we see the hospital as a place of health and one of healing, then we've done a good thing."

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