Rethinking the Service Line
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Technology also can play a role in improving patient engagement. Leaders at Hackensack University Medical Center discovered a need to better the cardiovascular service line to help prevent hospital readmissions and enhance patient satisfaction.
The University Health Network is the nonprofit New Jersey–based parent company of HackensackUMC and corporate joint venture partners with LHP Hospital Group, a Plano, Texas–based for-profit organization in ownership of two hospitals: HackensackUMC at Pascack Valley and HackensackUMC Mountainside.
As hospitals move from volume- to value-based healthcare programs, "interacting with our patient more often and more effectively" is a key to better outcomes and reduced readmissions, says Teichholz, the medical director for cardiac services at HackensackUMC.
"When you look at the statistics for congestive heart failure and heart attacks, we give excellent care. Our mortality rate is very low, but our readmission rate has not been at the top and is something we wanted to improve on," Teichholz says. "We were very concerned about moving that forward and, of course, the government will be penalizing hospitals for readmission rates."
Indeed, in 2012 HackensackUMC reported a 26.7% all-cause heart failure readmission rate for 1,889 patients, compared to 24.7% for the national average, according to the Centers for Medicare & Medicaid Services' Hospital Compare website. Within the past year, however, HackensackUMC decreased the all-cause heart failure readmission rate to about 21%–23%, Teichholz says.
HackensackUMC, as part of its effort to reduce readmissions, was among four
hospitals to participate in a pilot program designed to follow up with congestive heart failure patients after discharge. The hospital uses EmmiTransition—an automated, interactive system of outreach tools—to call patients for 45 straight days after discharge, reminding them when to schedule an appointment with their primary care doctor, take their medication, or complete other actions.
The voice response system asks patients questions, such as their weight, and reports the information to the hospital. The pilot program saved an estimated 600 hours and found more than 313 red flags—recognition of a possible risk factor, such as weight gain—that otherwise may not have been captured, according to Teichholz.
"Through at least one initial telephone call to every patient from our nursing staff, improvement in postdischarge instructions for all patients, and the use of Emmi, we have met our goal of decreasing all-cause CHF readmissions," Teichholz says.
"It did make a substantial difference compared to usual care. For congestive heart failure patients, the communication program has shown to be more effective than not using it, based on a comparative review." The program enabled the hospital to decrease readmissions of more than 60 patients by 20%–25%, he says. Total CHF readmissions are now 7% with a readmission diagnosis of CHF, Teichholz says.
"The key to preventing readmission is the engagement of patients," Teichholz says. "What we've learned is that trying to educate patients before they leave the hospital doesn't always work. They just want to go home. In this way, we're getting patients involved as a partner in their care and making sure that they make an appointment to see their primary care physician, making sure they get their medication and continue with the medication."
Joe Cantlupe is senior editor for physicians and service lines for HealthLeaders Media. He may be contacted at firstname.lastname@example.org.
This article appears in the March 2013 issue of HealthLeaders magazine.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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