Larry Beresford

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.

New technology that infuses a copper oxide into hard surfaces or fabrics in order to boost infection control could soon become a major weapon in hospitals, according to the CEOs of two Virginia companies now developing such technologies.

Cupron (http://www.cupron.com/), based in Richmond, Va., provides the infusion of a proprietary copper oxide compound into such hard surfaces as flooring, countertops, building components, and furniture, and into fabrics such as gowns, uniforms, and linens, says company chairman Paul Rocheleau. Cupron is partnering with EOS Surfaces (http://eos-surfaces.com/cupron/), based in Portsmouth, Va., a developer of solid countertop surfaces, which company president Ken Trinder says are thicker than comparable building products.

Together, the companies are seeking approval from the U.S. Environmental Protection Agency to market these products with registrations for their public health claims of preventing hospital-acquired infections (HAIs) caused by bacteria, fungi, and viruses. The products recently were tested against Staphylococcus and Enterobacter bacteria, with 99.9% effectiveness in killing organisms, Rocheleau says.

“It is well known that copper has the ability to kill pathogens,” he adds. “What’s new are the methods to deliver that technology.”

He calls the copper-ion technology an additional layer of infection control, meant not to supplant other hospital protocols but to become part of overall risk-management programs to control HAIs. Other Cupron products, such as anti-odor footwear, are already on the market, but EOS aims to market the hard-surface products to health facilities starting in the second half of this year. “We’re also well advanced on the first of several clinical studies of the impact of Cupron-infused textiles and hard surfaces on infection rates,” Rocheleau says.

Meanwhile, a new “intelligent handwash monitoring system” to promote hand hygiene compliance in order to prevent HAIs that is now being tested in the United Kingdom by the global thermal technology company Irisys (www.irisys.co.uk/) was presented at the Association for Professionals in Infection Control and Epidemiology 2012 conference in June in San Antonio.

It uses non-intrusive therapy sensors deployed throughout healthcare facilities to detect people’s movements and determine accurate counts of handwashing opportunities, which are then compared to actual handwashing (or sanitizing gel) occurrences. The intention is to promote greater compliance with infection-preventing hand hygiene without violating personal privacy, such as through the use of video surveillance.

New technology that infuses a copper oxide into hard surfaces or fabrics in order to boost infection control could soon become a major weapon in hospitals, according to the CEOs of two Virginia companies now developing such technologies.

Cupron (http://www.cupron.com/), based in Richmond, Va., provides the infusion of a proprietary copper oxide compound into such hard surfaces as flooring, countertops, building components, and furniture, and into fabrics such as gowns, uniforms, and linens, says company chairman Paul Rocheleau. Cupron is partnering with EOS Surfaces (http://eos-surfaces.com/cupron/), based in Portsmouth, Va., a developer of solid countertop surfaces, which company president Ken Trinder says are thicker than comparable building products.

Together, the companies are seeking approval from the U.S. Environmental Protection Agency to market these products with registrations for their public health claims of preventing hospital-acquired infections (HAIs) caused by bacteria, fungi, and viruses. The products recently were tested against Staphylococcus and Enterobacter bacteria, with 99.9% effectiveness in killing organisms, Rocheleau says.

“It is well known that copper has the ability to kill pathogens,” he adds. “What’s new are the methods to deliver that technology.”

He calls the copper-ion technology an additional layer of infection control, meant not to supplant other hospital protocols but to become part of overall risk-management programs to control HAIs. Other Cupron products, such as anti-odor footwear, are already on the market, but EOS aims to market the hard-surface products to health facilities starting in the second half of this year. “We’re also well advanced on the first of several clinical studies of the impact of Cupron-infused textiles and hard surfaces on infection rates,” Rocheleau says.

Meanwhile, a new “intelligent handwash monitoring system” to promote hand hygiene compliance in order to prevent HAIs that is now being tested in the United Kingdom by the global thermal technology company Irisys (www.irisys.co.uk/) was presented at the Association for Professionals in Infection Control and Epidemiology 2012 conference in June in San Antonio.

It uses non-intrusive therapy sensors deployed throughout healthcare facilities to detect people’s movements and determine accurate counts of handwashing opportunities, which are then compared to actual handwashing (or sanitizing gel) occurrences. The intention is to promote greater compliance with infection-preventing hand hygiene without violating personal privacy, such as through the use of video surveillance.

New technology that infuses a copper oxide into hard surfaces or fabrics in order to boost infection control could soon become a major weapon in hospitals, according to the CEOs of two Virginia companies now developing such technologies.

Cupron (http://www.cupron.com/), based in Richmond, Va., provides the infusion of a proprietary copper oxide compound into such hard surfaces as flooring, countertops, building components, and furniture, and into fabrics such as gowns, uniforms, and linens, says company chairman Paul Rocheleau. Cupron is partnering with EOS Surfaces (http://eos-surfaces.com/cupron/), based in Portsmouth, Va., a developer of solid countertop surfaces, which company president Ken Trinder says are thicker than comparable building products.

Together, the companies are seeking approval from the U.S. Environmental Protection Agency to market these products with registrations for their public health claims of preventing hospital-acquired infections (HAIs) caused by bacteria, fungi, and viruses. The products recently were tested against Staphylococcus and Enterobacter bacteria, with 99.9% effectiveness in killing organisms, Rocheleau says.

“It is well known that copper has the ability to kill pathogens,” he adds. “What’s new are the methods to deliver that technology.”

He calls the copper-ion technology an additional layer of infection control, meant not to supplant other hospital protocols but to become part of overall risk-management programs to control HAIs. Other Cupron products, such as anti-odor footwear, are already on the market, but EOS aims to market the hard-surface products to health facilities starting in the second half of this year. “We’re also well advanced on the first of several clinical studies of the impact of Cupron-infused textiles and hard surfaces on infection rates,” Rocheleau says.

Meanwhile, a new “intelligent handwash monitoring system” to promote hand hygiene compliance in order to prevent HAIs that is now being tested in the United Kingdom by the global thermal technology company Irisys (www.irisys.co.uk/) was presented at the Association for Professionals in Infection Control and Epidemiology 2012 conference in June in San Antonio.

It uses non-intrusive therapy sensors deployed throughout healthcare facilities to detect people’s movements and determine accurate counts of handwashing opportunities, which are then compared to actual handwashing (or sanitizing gel) occurrences. The intention is to promote greater compliance with infection-preventing hand hygiene without violating personal privacy, such as through the use of video surveillance.

A new study in the Journal of the American Medical Informatics Association offers demographic predictors of physicians and their usage of web-based communication technologies.¹ Younger, male doctors who have privileges at a teaching hospital were better predictors of the use of various technologies during the previous six months than were practice-based characteristics, such as specialty, setting, years in practice, or number of patients treated. Communication strategies tallied included using portable devices to access the Internet, visiting social networking websites, communicating by email with patients, listening to podcasts, or writing blog posts.

Lead author Crystale Purvis Cooper, PhD, a researcher at the Soltera Center for Cancer Prevention and Control in Tucson, Ariz., and colleagues drew upon 2009 data from 1,750 physicians in DocStyles, an annual survey of physicians and other health professionals conducted by communications firm Porter Novelli.

References

1. Cooper CP, Gelb CA, Rim SH, Hawkins NA, Rodriguez JL, Polonec L. Physicians who use social media and other internet-based communication technologies. J Am Med Inform Assoc. 2012 May 25 [Epub ahead of print].

A new study in the Journal of the American Medical Informatics Association offers demographic predictors of physicians and their usage of web-based communication technologies.¹ Younger, male doctors who have privileges at a teaching hospital were better predictors of the use of various technologies during the previous six months than were practice-based characteristics, such as specialty, setting, years in practice, or number of patients treated. Communication strategies tallied included using portable devices to access the Internet, visiting social networking websites, communicating by email with patients, listening to podcasts, or writing blog posts.

Lead author Crystale Purvis Cooper, PhD, a researcher at the Soltera Center for Cancer Prevention and Control in Tucson, Ariz., and colleagues drew upon 2009 data from 1,750 physicians in DocStyles, an annual survey of physicians and other health professionals conducted by communications firm Porter Novelli.

References

1. Cooper CP, Gelb CA, Rim SH, Hawkins NA, Rodriguez JL, Polonec L. Physicians who use social media and other internet-based communication technologies. J Am Med Inform Assoc. 2012 May 25 [Epub ahead of print].

A new study in the Journal of the American Medical Informatics Association offers demographic predictors of physicians and their usage of web-based communication technologies.¹ Younger, male doctors who have privileges at a teaching hospital were better predictors of the use of various technologies during the previous six months than were practice-based characteristics, such as specialty, setting, years in practice, or number of patients treated. Communication strategies tallied included using portable devices to access the Internet, visiting social networking websites, communicating by email with patients, listening to podcasts, or writing blog posts.

Lead author Crystale Purvis Cooper, PhD, a researcher at the Soltera Center for Cancer Prevention and Control in Tucson, Ariz., and colleagues drew upon 2009 data from 1,750 physicians in DocStyles, an annual survey of physicians and other health professionals conducted by communications firm Porter Novelli.

References

1. Cooper CP, Gelb CA, Rim SH, Hawkins NA, Rodriguez JL, Polonec L. Physicians who use social media and other internet-based communication technologies. J Am Med Inform Assoc. 2012 May 25 [Epub ahead of print].

Average annual number of hospitalized adult patients with a venous thromboembolism (VTE) during 2007 to 2009.

A total of 348,558 hospitalized patients had deep vein thromboses, 277,549 had pulmonary embolisms, and 78,511 had both, according to estimates compiled for the federal Centers for Disease Control and Prevention (CDC).¹ Of those patients with hospital VTEs, 28,726 die each year. The risk for VTE is known to be elevated in hospitalized patients due to major surgery, immobility, or comorbid conditions. Although it can often be prevented through appropriate administration of prophylaxis—either pharmacologic agents or mechanical devices—

CDC notes that “current use of prophylaxis in hospitalized patients might be suboptimal.”

Reference

1. Centers for Disease Control and Prevention. Venous thromboembolism in adult hospitalizations—United States, 2007-2009. MMWR Morb Mortal Wkly Rep. 2012;61:401-404.

Average annual number of hospitalized adult patients with a venous thromboembolism (VTE) during 2007 to 2009.

A total of 348,558 hospitalized patients had deep vein thromboses, 277,549 had pulmonary embolisms, and 78,511 had both, according to estimates compiled for the federal Centers for Disease Control and Prevention (CDC).¹ Of those patients with hospital VTEs, 28,726 die each year. The risk for VTE is known to be elevated in hospitalized patients due to major surgery, immobility, or comorbid conditions. Although it can often be prevented through appropriate administration of prophylaxis—either pharmacologic agents or mechanical devices—

CDC notes that “current use of prophylaxis in hospitalized patients might be suboptimal.”

Reference

1. Centers for Disease Control and Prevention. Venous thromboembolism in adult hospitalizations—United States, 2007-2009. MMWR Morb Mortal Wkly Rep. 2012;61:401-404.

Average annual number of hospitalized adult patients with a venous thromboembolism (VTE) during 2007 to 2009.

A total of 348,558 hospitalized patients had deep vein thromboses, 277,549 had pulmonary embolisms, and 78,511 had both, according to estimates compiled for the federal Centers for Disease Control and Prevention (CDC).¹ Of those patients with hospital VTEs, 28,726 die each year. The risk for VTE is known to be elevated in hospitalized patients due to major surgery, immobility, or comorbid conditions. Although it can often be prevented through appropriate administration of prophylaxis—either pharmacologic agents or mechanical devices—

CDC notes that “current use of prophylaxis in hospitalized patients might be suboptimal.”

Reference

1. Centers for Disease Control and Prevention. Venous thromboembolism in adult hospitalizations—United States, 2007-2009. MMWR Morb Mortal Wkly Rep. 2012;61:401-404.

A hospital observation unit run by hospitalists rather than the more typical model led by ED physicians can be financially viable, suggests an abstract presented at HM12 in April in San Diego. One such unit generated $915,000 in facility fee charges, and during a three-month audit posted net revenue of $49,000; the unit also reduced patients’ length of stay (LOS) on observation status by 25%, according to lead author Mary Maher, MD, a hospitalist at Denver Health Medical Center.¹

Previously, Denver Health’s ED had informally operated a small observation unit, primarily for patients with such diagnoses as low-risk chest pain. But due to increasing numbers of observation admissions and the need to manage their flow through the typically full safety-net teaching hospital, the hospitalist department was asked in 2011 to develop a new, hospitalist-run unit, Dr. Maher explains.

In its first six months of operation, the five-bed observation unit cared for 648 patients, with 12% admitted to the hospital. A single hospitalist and mid-level practitioner cover each shift, with additional responsibilities for managing patient flow and new hospital admissions. Dr. Maher says specialized nursing staffers are now familiar with the hospital’s admission criteria and care pathways for common diagnoses. A typical observation patient has chest pain and a history of coronary artery disease but negative clinical markers. Other common diagnoses, with established clinical pathways and discharge criteria, include asthma, syncope, COPD, and gastrointestinal illness.

“Hospitalists are primed to take care of patients who are in this observation status,” Dr. Maher says. “They are a little more complex than patients typically seen in emergency department units. The challenge for hospitalists is to understand the hospital’s admission guidelines and to work collaboratively with utilization management staff.”

Denver Health uses the Milliman Care Guidelines to guide inpatient admissions, but these can be difficult to translate into clinical practice and require some study by physicians, she adds.² For more information about the poster and the unit, email [email protected].

References

1. Maher M, Mascolo M, Mancini D, et al. Creation of a financially viable hospitalist-run observation unit in a safety net hospital. Paper presented at Hospital Medicine 2012, April 1-4, 2012, San Diego.
2. Milliman Inc. Milliman Care Guidelines. Milliman Inc. website. Available at: http://www.milliman.com/expertise/healthcare/products-tools/milliman-care-guidelines/. Accessed July 8, 2012.

A hospital observation unit run by hospitalists rather than the more typical model led by ED physicians can be financially viable, suggests an abstract presented at HM12 in April in San Diego. One such unit generated $915,000 in facility fee charges, and during a three-month audit posted net revenue of $49,000; the unit also reduced patients’ length of stay (LOS) on observation status by 25%, according to lead author Mary Maher, MD, a hospitalist at Denver Health Medical Center.¹

Previously, Denver Health’s ED had informally operated a small observation unit, primarily for patients with such diagnoses as low-risk chest pain. But due to increasing numbers of observation admissions and the need to manage their flow through the typically full safety-net teaching hospital, the hospitalist department was asked in 2011 to develop a new, hospitalist-run unit, Dr. Maher explains.

In its first six months of operation, the five-bed observation unit cared for 648 patients, with 12% admitted to the hospital. A single hospitalist and mid-level practitioner cover each shift, with additional responsibilities for managing patient flow and new hospital admissions. Dr. Maher says specialized nursing staffers are now familiar with the hospital’s admission criteria and care pathways for common diagnoses. A typical observation patient has chest pain and a history of coronary artery disease but negative clinical markers. Other common diagnoses, with established clinical pathways and discharge criteria, include asthma, syncope, COPD, and gastrointestinal illness.

“Hospitalists are primed to take care of patients who are in this observation status,” Dr. Maher says. “They are a little more complex than patients typically seen in emergency department units. The challenge for hospitalists is to understand the hospital’s admission guidelines and to work collaboratively with utilization management staff.”

Denver Health uses the Milliman Care Guidelines to guide inpatient admissions, but these can be difficult to translate into clinical practice and require some study by physicians, she adds.² For more information about the poster and the unit, email [email protected].

References

1. Maher M, Mascolo M, Mancini D, et al. Creation of a financially viable hospitalist-run observation unit in a safety net hospital. Paper presented at Hospital Medicine 2012, April 1-4, 2012, San Diego.
2. Milliman Inc. Milliman Care Guidelines. Milliman Inc. website. Available at: http://www.milliman.com/expertise/healthcare/products-tools/milliman-care-guidelines/. Accessed July 8, 2012.

A hospital observation unit run by hospitalists rather than the more typical model led by ED physicians can be financially viable, suggests an abstract presented at HM12 in April in San Diego. One such unit generated $915,000 in facility fee charges, and during a three-month audit posted net revenue of $49,000; the unit also reduced patients’ length of stay (LOS) on observation status by 25%, according to lead author Mary Maher, MD, a hospitalist at Denver Health Medical Center.¹

Previously, Denver Health’s ED had informally operated a small observation unit, primarily for patients with such diagnoses as low-risk chest pain. But due to increasing numbers of observation admissions and the need to manage their flow through the typically full safety-net teaching hospital, the hospitalist department was asked in 2011 to develop a new, hospitalist-run unit, Dr. Maher explains.

In its first six months of operation, the five-bed observation unit cared for 648 patients, with 12% admitted to the hospital. A single hospitalist and mid-level practitioner cover each shift, with additional responsibilities for managing patient flow and new hospital admissions. Dr. Maher says specialized nursing staffers are now familiar with the hospital’s admission criteria and care pathways for common diagnoses. A typical observation patient has chest pain and a history of coronary artery disease but negative clinical markers. Other common diagnoses, with established clinical pathways and discharge criteria, include asthma, syncope, COPD, and gastrointestinal illness.

“Hospitalists are primed to take care of patients who are in this observation status,” Dr. Maher says. “They are a little more complex than patients typically seen in emergency department units. The challenge for hospitalists is to understand the hospital’s admission guidelines and to work collaboratively with utilization management staff.”

Denver Health uses the Milliman Care Guidelines to guide inpatient admissions, but these can be difficult to translate into clinical practice and require some study by physicians, she adds.² For more information about the poster and the unit, email [email protected].

References

1. Maher M, Mascolo M, Mancini D, et al. Creation of a financially viable hospitalist-run observation unit in a safety net hospital. Paper presented at Hospital Medicine 2012, April 1-4, 2012, San Diego.
2. Milliman Inc. Milliman Care Guidelines. Milliman Inc. website. Available at: http://www.milliman.com/expertise/healthcare/products-tools/milliman-care-guidelines/. Accessed July 8, 2012.

The most recent report on hospital quality issued by independent healthcare rating company HealthGrades estimates that 254,000 safety incidents that occurred in U.S. hospitals from 2008 to 2010 could have been prevented, and that 56,367 hospitalized patients who died experienced one or more of those preventable events.¹

Drawing upon consumer-reported quality data in CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, HealthGrades concluded that 15% more patient safety incidents occurred at hospitals who ranked lowest (the bottom 10%) on the quality of their physician communication.

Reference

1. CPM Healthgrades. Patient safety and satisfaction: the state of American hospitals. CPM Healthgrades website. Available at: https://www.cpm.com/CPM/assets/File/HealthGradesPatientSafetySatisfactionReport2012.pdf. Accessed July 8, 2012.

The most recent report on hospital quality issued by independent healthcare rating company HealthGrades estimates that 254,000 safety incidents that occurred in U.S. hospitals from 2008 to 2010 could have been prevented, and that 56,367 hospitalized patients who died experienced one or more of those preventable events.¹

Drawing upon consumer-reported quality data in CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, HealthGrades concluded that 15% more patient safety incidents occurred at hospitals who ranked lowest (the bottom 10%) on the quality of their physician communication.

Reference

1. CPM Healthgrades. Patient safety and satisfaction: the state of American hospitals. CPM Healthgrades website. Available at: https://www.cpm.com/CPM/assets/File/HealthGradesPatientSafetySatisfactionReport2012.pdf. Accessed July 8, 2012.

The most recent report on hospital quality issued by independent healthcare rating company HealthGrades estimates that 254,000 safety incidents that occurred in U.S. hospitals from 2008 to 2010 could have been prevented, and that 56,367 hospitalized patients who died experienced one or more of those preventable events.¹

Drawing upon consumer-reported quality data in CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, HealthGrades concluded that 15% more patient safety incidents occurred at hospitals who ranked lowest (the bottom 10%) on the quality of their physician communication.

Reference

1. CPM Healthgrades. Patient safety and satisfaction: the state of American hospitals. CPM Healthgrades website. Available at: https://www.cpm.com/CPM/assets/File/HealthGradesPatientSafetySatisfactionReport2012.pdf. Accessed July 8, 2012.

When Harbor UCLA Medical Center, a teaching hospital in Torrance, Calif., and a major safety-net facility for Los Angeles County, looked at its 30-day readmissions data, it found that readmissions for heart failure patients had increased by about 25% in just one year.

“We parsed the data and said we’re going have to sort this out,” explains Charles McKay, MD, a cardiologist at the hospital. “Then the opportunity to join Project BOOST came along. It’s been helpful to have their tools, mentors, and the whole collaborative experience.”

Harbor UCLA is one of seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, co-sponsored by SHM and the Hospital Association of Southern California (HASC). The hospitals convened in early June in Montebello, Calif., to report results from their quality initiatives. Four of the hospitals reported reductions in readmissions ranging from 24% to 55%. The other three were slower in implementing their quality processes and are just now starting to see results, executives said.

Project BOOST is a national quality initiative created by SHM to improve hospital discharges and care transitions while reducing readmissions—a growing focus for hospitals and health policy makers. About 100 participating sites across the country have benefited from BOOST’s expert mentoring and collaboration, as well as access to such tools as the “teachback” communication techniques and the “8Ps” comprehensive patient risk assessment.

Harbor UCLA’s multidisciplinary readmissions team, with Dr. McKay as its physician champion, zeroed in on heart failure and developed a Cardiovascular Open Access Rapid Evaluation (CORE) service, which he describes as a sort of observation or clinical decisions unit aimed at relieving pressure on the ED. Open 7 a.m. to 7 p.m., the CORE service coordinates medical interventions—stress tests and trips to the cardiac catheter lab, for example—for patients who have not been admitted to the hospital.

The team also focuses on discharged patients who return to the hospital within 72 hours, before the hospital could place post-discharge follow-up phone calls. Many of these patients could not be reached after they left the hospital.

“These are the patients where the system has failed,” Dr. McKay says. “But you could flip it over and say they are our biggest opportunity. That’s where BOOST comes in, to talk about interventions during hospitalization, implementing teachback, streamlining the coordination of care.”

BOOST aims to accelerate the quality-improvement (QI) process, identifying readmission risks and making them a higher priority for nurses and doctors to mobilize resources in the discharge process. “That’s where BOOST shone at our institution,” Dr. McKay says, “and where we still have a lot to learn.”

Harbor UCLA also brought a home healthcare representative onto the team, engaged a discharge advocate, and referred appropriate patients to a heart failure disease management registry. Over the year of the collaborative, it posted a 5.5% decrease in readmissions of heart failure patients.

Hospitalists do not have prominent roles at most HASC readmissions sites; traditional hospitalist services are less common in Southern California hospitals, in part due to the prevalence of independent practice associations (IPAs), which act as intermediaries between physicians and health plans in the region, explains Z. Joseph Wanski, MD, FACE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. “The IPA is in charge of its members’ hospital and post-hospital care,” he says.

Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care is now testing the use of hospitalists at some of its contracted acute-care facilities.

 

In many cases, readmissions involve avoidable costs, as well as reduce patient satisfaction. “If they do not get rehospitalized, patients are happier, their caretakers are happier, and I feel the quality of their care is better,” Dr. Wanski says. “If you can keep the person well at home, make sure they take their medications, hopefully not go back to the ER, and get on with their lives—all those things together are why we’re supporting this collaborative.”

But hospitalists, especially in larger groups, potentially have the leverage to negotiate access to services and the care coordination needed to reduce hospital costs and preventable readmissions, Dr. McKay notes. “In 2012, hospitalists are key, and we need to find a way to make readmission reduction part of their job description, so that they can direct that,” he says.

At Valley Presbyterian Hospital in Van Nuys, which employs three part-time hospitalists who also maintain busy office practices, “the hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the hospital’s full-time Project BOOST facilitator. “They see a lot of our patients in their offices.” The physicians have agreed to carve out time to see, within seven days, discharge patients going home without scheduled appointments with their primary-care physicians (PCPs).

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments” and decline the hospital team’s offers for help—which makes it important for the discharge coordinator to follow up as soon as possible after the patient goes home, Quintero says.

At the collaborative congress in early June, team member Alice Gunderson reported results for Saint Francis Hospital in Lynwood. Gunderson, who sits on the hospital’s quality and safety board, has been a volunteer patient family advocate (PFA) for the past year and a half; she was inspired by her own experience as a family caregiver for her husband and mother, both of whom were Saint Francis patients. Gunderson challenged those in the audience to bring a PFA from their own hospital to the next BOOST meeting.

“From my point of view, wherever healthcare goes, the patient is becoming more educated, with all of the communication technology that is out there, and claiming that empowerment,” Gunderson says. “We must all work together, not in separate silos, for the best outcomes, and we can all learn from one another.”

Larry Beresford is a freelance writer in Oakland, Calif.

When Harbor UCLA Medical Center, a teaching hospital in Torrance, Calif., and a major safety-net facility for Los Angeles County, looked at its 30-day readmissions data, it found that readmissions for heart failure patients had increased by about 25% in just one year.

“We parsed the data and said we’re going have to sort this out,” explains Charles McKay, MD, a cardiologist at the hospital. “Then the opportunity to join Project BOOST came along. It’s been helpful to have their tools, mentors, and the whole collaborative experience.”

Harbor UCLA is one of seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, co-sponsored by SHM and the Hospital Association of Southern California (HASC). The hospitals convened in early June in Montebello, Calif., to report results from their quality initiatives. Four of the hospitals reported reductions in readmissions ranging from 24% to 55%. The other three were slower in implementing their quality processes and are just now starting to see results, executives said.

Project BOOST is a national quality initiative created by SHM to improve hospital discharges and care transitions while reducing readmissions—a growing focus for hospitals and health policy makers. About 100 participating sites across the country have benefited from BOOST’s expert mentoring and collaboration, as well as access to such tools as the “teachback” communication techniques and the “8Ps” comprehensive patient risk assessment.

Harbor UCLA’s multidisciplinary readmissions team, with Dr. McKay as its physician champion, zeroed in on heart failure and developed a Cardiovascular Open Access Rapid Evaluation (CORE) service, which he describes as a sort of observation or clinical decisions unit aimed at relieving pressure on the ED. Open 7 a.m. to 7 p.m., the CORE service coordinates medical interventions—stress tests and trips to the cardiac catheter lab, for example—for patients who have not been admitted to the hospital.

The team also focuses on discharged patients who return to the hospital within 72 hours, before the hospital could place post-discharge follow-up phone calls. Many of these patients could not be reached after they left the hospital.

“These are the patients where the system has failed,” Dr. McKay says. “But you could flip it over and say they are our biggest opportunity. That’s where BOOST comes in, to talk about interventions during hospitalization, implementing teachback, streamlining the coordination of care.”

BOOST aims to accelerate the quality-improvement (QI) process, identifying readmission risks and making them a higher priority for nurses and doctors to mobilize resources in the discharge process. “That’s where BOOST shone at our institution,” Dr. McKay says, “and where we still have a lot to learn.”

Harbor UCLA also brought a home healthcare representative onto the team, engaged a discharge advocate, and referred appropriate patients to a heart failure disease management registry. Over the year of the collaborative, it posted a 5.5% decrease in readmissions of heart failure patients.

Hospitalists do not have prominent roles at most HASC readmissions sites; traditional hospitalist services are less common in Southern California hospitals, in part due to the prevalence of independent practice associations (IPAs), which act as intermediaries between physicians and health plans in the region, explains Z. Joseph Wanski, MD, FACE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. “The IPA is in charge of its members’ hospital and post-hospital care,” he says.

Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care is now testing the use of hospitalists at some of its contracted acute-care facilities.

 

In many cases, readmissions involve avoidable costs, as well as reduce patient satisfaction. “If they do not get rehospitalized, patients are happier, their caretakers are happier, and I feel the quality of their care is better,” Dr. Wanski says. “If you can keep the person well at home, make sure they take their medications, hopefully not go back to the ER, and get on with their lives—all those things together are why we’re supporting this collaborative.”

But hospitalists, especially in larger groups, potentially have the leverage to negotiate access to services and the care coordination needed to reduce hospital costs and preventable readmissions, Dr. McKay notes. “In 2012, hospitalists are key, and we need to find a way to make readmission reduction part of their job description, so that they can direct that,” he says.

At Valley Presbyterian Hospital in Van Nuys, which employs three part-time hospitalists who also maintain busy office practices, “the hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the hospital’s full-time Project BOOST facilitator. “They see a lot of our patients in their offices.” The physicians have agreed to carve out time to see, within seven days, discharge patients going home without scheduled appointments with their primary-care physicians (PCPs).

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments” and decline the hospital team’s offers for help—which makes it important for the discharge coordinator to follow up as soon as possible after the patient goes home, Quintero says.

At the collaborative congress in early June, team member Alice Gunderson reported results for Saint Francis Hospital in Lynwood. Gunderson, who sits on the hospital’s quality and safety board, has been a volunteer patient family advocate (PFA) for the past year and a half; she was inspired by her own experience as a family caregiver for her husband and mother, both of whom were Saint Francis patients. Gunderson challenged those in the audience to bring a PFA from their own hospital to the next BOOST meeting.

“From my point of view, wherever healthcare goes, the patient is becoming more educated, with all of the communication technology that is out there, and claiming that empowerment,” Gunderson says. “We must all work together, not in separate silos, for the best outcomes, and we can all learn from one another.”

Larry Beresford is a freelance writer in Oakland, Calif.

When Harbor UCLA Medical Center, a teaching hospital in Torrance, Calif., and a major safety-net facility for Los Angeles County, looked at its 30-day readmissions data, it found that readmissions for heart failure patients had increased by about 25% in just one year.

“We parsed the data and said we’re going have to sort this out,” explains Charles McKay, MD, a cardiologist at the hospital. “Then the opportunity to join Project BOOST came along. It’s been helpful to have their tools, mentors, and the whole collaborative experience.”

Harbor UCLA is one of seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, co-sponsored by SHM and the Hospital Association of Southern California (HASC). The hospitals convened in early June in Montebello, Calif., to report results from their quality initiatives. Four of the hospitals reported reductions in readmissions ranging from 24% to 55%. The other three were slower in implementing their quality processes and are just now starting to see results, executives said.

Project BOOST is a national quality initiative created by SHM to improve hospital discharges and care transitions while reducing readmissions—a growing focus for hospitals and health policy makers. About 100 participating sites across the country have benefited from BOOST’s expert mentoring and collaboration, as well as access to such tools as the “teachback” communication techniques and the “8Ps” comprehensive patient risk assessment.

Harbor UCLA’s multidisciplinary readmissions team, with Dr. McKay as its physician champion, zeroed in on heart failure and developed a Cardiovascular Open Access Rapid Evaluation (CORE) service, which he describes as a sort of observation or clinical decisions unit aimed at relieving pressure on the ED. Open 7 a.m. to 7 p.m., the CORE service coordinates medical interventions—stress tests and trips to the cardiac catheter lab, for example—for patients who have not been admitted to the hospital.

The team also focuses on discharged patients who return to the hospital within 72 hours, before the hospital could place post-discharge follow-up phone calls. Many of these patients could not be reached after they left the hospital.

“These are the patients where the system has failed,” Dr. McKay says. “But you could flip it over and say they are our biggest opportunity. That’s where BOOST comes in, to talk about interventions during hospitalization, implementing teachback, streamlining the coordination of care.”

BOOST aims to accelerate the quality-improvement (QI) process, identifying readmission risks and making them a higher priority for nurses and doctors to mobilize resources in the discharge process. “That’s where BOOST shone at our institution,” Dr. McKay says, “and where we still have a lot to learn.”

Harbor UCLA also brought a home healthcare representative onto the team, engaged a discharge advocate, and referred appropriate patients to a heart failure disease management registry. Over the year of the collaborative, it posted a 5.5% decrease in readmissions of heart failure patients.

Hospitalists do not have prominent roles at most HASC readmissions sites; traditional hospitalist services are less common in Southern California hospitals, in part due to the prevalence of independent practice associations (IPAs), which act as intermediaries between physicians and health plans in the region, explains Z. Joseph Wanski, MD, FACE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. “The IPA is in charge of its members’ hospital and post-hospital care,” he says.

Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care is now testing the use of hospitalists at some of its contracted acute-care facilities.

 

In many cases, readmissions involve avoidable costs, as well as reduce patient satisfaction. “If they do not get rehospitalized, patients are happier, their caretakers are happier, and I feel the quality of their care is better,” Dr. Wanski says. “If you can keep the person well at home, make sure they take their medications, hopefully not go back to the ER, and get on with their lives—all those things together are why we’re supporting this collaborative.”

But hospitalists, especially in larger groups, potentially have the leverage to negotiate access to services and the care coordination needed to reduce hospital costs and preventable readmissions, Dr. McKay notes. “In 2012, hospitalists are key, and we need to find a way to make readmission reduction part of their job description, so that they can direct that,” he says.

At Valley Presbyterian Hospital in Van Nuys, which employs three part-time hospitalists who also maintain busy office practices, “the hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the hospital’s full-time Project BOOST facilitator. “They see a lot of our patients in their offices.” The physicians have agreed to carve out time to see, within seven days, discharge patients going home without scheduled appointments with their primary-care physicians (PCPs).

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments” and decline the hospital team’s offers for help—which makes it important for the discharge coordinator to follow up as soon as possible after the patient goes home, Quintero says.

At the collaborative congress in early June, team member Alice Gunderson reported results for Saint Francis Hospital in Lynwood. Gunderson, who sits on the hospital’s quality and safety board, has been a volunteer patient family advocate (PFA) for the past year and a half; she was inspired by her own experience as a family caregiver for her husband and mother, both of whom were Saint Francis patients. Gunderson challenged those in the audience to bring a PFA from their own hospital to the next BOOST meeting.

“From my point of view, wherever healthcare goes, the patient is becoming more educated, with all of the communication technology that is out there, and claiming that empowerment,” Gunderson says. “We must all work together, not in separate silos, for the best outcomes, and we can all learn from one another.”

Larry Beresford is a freelance writer in Oakland, Calif.

Unpublished data from a British study of dedicated psychiatric hospitalists shows clear improvements in 17 of 23 measured outcomes, according to the study's lead researcher.

Julian Beezhold, MD, a consultant in emergency psychiatry at Norfolk and Suffolk NHS Foundation Trust (formerly Norfolk and Waveney Mental Health Foundation Trust) presented the data at the annual meeting of the American Psychiatric Association in May in Philadelphia.

The researchers investigated 5,000 patients over nearly eight years. By switching coverage from 13 consultant psychiatrists to dedicated-unit psychiatric hospitalists, the study showed lengths of stay on two inpatient psychiatry units cut in half (just over 11 days from nearly 22 days). Researchers also found reductions in violent episodes and self-harm. Demand for beds on the units declined steadily during the study, resulting in consolidation down to one unit.

"We found overwhelming, robust evidence showing clear benefit from a hospitalist model of care," Dr. Beezhold says. "We found that dedicated doctors are able to achieve better quality of care simply because they are there, able to respond to crises and to change treatment plans more quickly when that is needed."

Psychiatry practice differs from most specialty practice in the United Kingdom, he adds, but the recent trend has been toward a larger division between office-based and hospital-based practices.

In the U.S., models of coverage for acute psychiatric patients include specialized psychiatric hospitals, dedicated psychiatric units within general hospitals, and patients admitted to general hospital units whose psychiatric care is managed by consultation-liaison psychiatrists, says Abigail Donovan, MD, a psychiatrist at Massachusetts General Hospital in Boston.

"At Mass General, we have access to all of these approaches," she says, adding that the new data "reinforces the way we've been doing things with dedicated psychiatric hospitalists—showing the tangible results of this model."

Unpublished data from a British study of dedicated psychiatric hospitalists shows clear improvements in 17 of 23 measured outcomes, according to the study's lead researcher.

Julian Beezhold, MD, a consultant in emergency psychiatry at Norfolk and Suffolk NHS Foundation Trust (formerly Norfolk and Waveney Mental Health Foundation Trust) presented the data at the annual meeting of the American Psychiatric Association in May in Philadelphia.

The researchers investigated 5,000 patients over nearly eight years. By switching coverage from 13 consultant psychiatrists to dedicated-unit psychiatric hospitalists, the study showed lengths of stay on two inpatient psychiatry units cut in half (just over 11 days from nearly 22 days). Researchers also found reductions in violent episodes and self-harm. Demand for beds on the units declined steadily during the study, resulting in consolidation down to one unit.

"We found overwhelming, robust evidence showing clear benefit from a hospitalist model of care," Dr. Beezhold says. "We found that dedicated doctors are able to achieve better quality of care simply because they are there, able to respond to crises and to change treatment plans more quickly when that is needed."

Psychiatry practice differs from most specialty practice in the United Kingdom, he adds, but the recent trend has been toward a larger division between office-based and hospital-based practices.

In the U.S., models of coverage for acute psychiatric patients include specialized psychiatric hospitals, dedicated psychiatric units within general hospitals, and patients admitted to general hospital units whose psychiatric care is managed by consultation-liaison psychiatrists, says Abigail Donovan, MD, a psychiatrist at Massachusetts General Hospital in Boston.

"At Mass General, we have access to all of these approaches," she says, adding that the new data "reinforces the way we've been doing things with dedicated psychiatric hospitalists—showing the tangible results of this model."

Unpublished data from a British study of dedicated psychiatric hospitalists shows clear improvements in 17 of 23 measured outcomes, according to the study's lead researcher.

Julian Beezhold, MD, a consultant in emergency psychiatry at Norfolk and Suffolk NHS Foundation Trust (formerly Norfolk and Waveney Mental Health Foundation Trust) presented the data at the annual meeting of the American Psychiatric Association in May in Philadelphia.

The researchers investigated 5,000 patients over nearly eight years. By switching coverage from 13 consultant psychiatrists to dedicated-unit psychiatric hospitalists, the study showed lengths of stay on two inpatient psychiatry units cut in half (just over 11 days from nearly 22 days). Researchers also found reductions in violent episodes and self-harm. Demand for beds on the units declined steadily during the study, resulting in consolidation down to one unit.

"We found overwhelming, robust evidence showing clear benefit from a hospitalist model of care," Dr. Beezhold says. "We found that dedicated doctors are able to achieve better quality of care simply because they are there, able to respond to crises and to change treatment plans more quickly when that is needed."

Psychiatry practice differs from most specialty practice in the United Kingdom, he adds, but the recent trend has been toward a larger division between office-based and hospital-based practices.

In the U.S., models of coverage for acute psychiatric patients include specialized psychiatric hospitals, dedicated psychiatric units within general hospitals, and patients admitted to general hospital units whose psychiatric care is managed by consultation-liaison psychiatrists, says Abigail Donovan, MD, a psychiatrist at Massachusetts General Hospital in Boston.

"At Mass General, we have access to all of these approaches," she says, adding that the new data "reinforces the way we've been doing things with dedicated psychiatric hospitalists—showing the tangible results of this model."

Seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, modeled after Project BOOST and sponsored by SHM and the Hospital Association of Southern California (HASC), reported on their experience at a June meeting in Montebello, Calif. Quality teams from four of the seven hospitals demonstrated reductions in readmission rates ranging from 24% to 55%. The other three hospitals are still implementing quality processes and are just now starting to see measurable results.

Several of the participating hospitals do not employ traditional hospitalist services. However, all seven benefit from mentoring by Project BOOST experts and have adopted a number of its approaches and techniques: 72-hour follow-up calls to discharged patients, the use of discharge advocates, medication reconciliation at time of discharge, enhanced discharge planning, and BOOST’s “8Ps” patient risk stratification tool. Another popular approach in use is the “teachback” communication technique, in which patients are asked to repeat in their own words what they understand the professional has told them about their condition and self-care.

One reason many Southern California hospitals do not have a strong hospitalist presence is the widespread prevalence of independent practice associations (IPAs), which often designate members of their medical groups to fill the hospitalist role for patients at a given hospital, says Z. Joseph Wanski, MD, FA

CE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care will be testing the use of hospitalists at some of its contracted acute-care facilities starting in July. (Click here to listen to more of Dr. Wanski’s interview.)

At Harbor UCLA Medical Center in Torrance, a major safety-net facility for Los Angeles County, the readmissions team initially focused on heart failure patients and was able to demonstrate a 5.5% decrease in readmissions for all heart failure patients at a time when readmissions for the hospital as a whole remained the same. The team built relationships with outside partners, including a nearby adult daycare center, home health agencies, and a care-transitions coach while emphasizing early identification of patients for referral to a heart failure disease management registry. The readmissions team also was instrumental in developing the Cardiovascular Open Access Rapid Evaluation (CORE) service, an observation unit for heart failure patients aimed at allieviating ED overcrowding.

“Hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the full-time Project BOOST facilitator at Valley Presbyterian Hospital in Van Nuys. “They see a lot of our patients in their offices.”

Three Valley Presbyterian physicians who work part-time as hospitalists and maintain office practices have agreed to carve out time to see patients who are going home without scheduled appointments with their primary-care physicians (PCPs) within seven days of discharge.

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments,” says Quintero, adding that such patients often decline the hospital team’s offers for help. The readmissions team at Valley Presbyterian is redesigning its clinical multidisciplinary rounds using a rounding script focusing more on discharge planning in rounding.

Larry Beresford is a freelance writer in Oakland, Calif.

Seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, modeled after Project BOOST and sponsored by SHM and the Hospital Association of Southern California (HASC), reported on their experience at a June meeting in Montebello, Calif. Quality teams from four of the seven hospitals demonstrated reductions in readmission rates ranging from 24% to 55%. The other three hospitals are still implementing quality processes and are just now starting to see measurable results.

Several of the participating hospitals do not employ traditional hospitalist services. However, all seven benefit from mentoring by Project BOOST experts and have adopted a number of its approaches and techniques: 72-hour follow-up calls to discharged patients, the use of discharge advocates, medication reconciliation at time of discharge, enhanced discharge planning, and BOOST’s “8Ps” patient risk stratification tool. Another popular approach in use is the “teachback” communication technique, in which patients are asked to repeat in their own words what they understand the professional has told them about their condition and self-care.

One reason many Southern California hospitals do not have a strong hospitalist presence is the widespread prevalence of independent practice associations (IPAs), which often designate members of their medical groups to fill the hospitalist role for patients at a given hospital, says Z. Joseph Wanski, MD, FA

CE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care will be testing the use of hospitalists at some of its contracted acute-care facilities starting in July. (Click here to listen to more of Dr. Wanski’s interview.)

At Harbor UCLA Medical Center in Torrance, a major safety-net facility for Los Angeles County, the readmissions team initially focused on heart failure patients and was able to demonstrate a 5.5% decrease in readmissions for all heart failure patients at a time when readmissions for the hospital as a whole remained the same. The team built relationships with outside partners, including a nearby adult daycare center, home health agencies, and a care-transitions coach while emphasizing early identification of patients for referral to a heart failure disease management registry. The readmissions team also was instrumental in developing the Cardiovascular Open Access Rapid Evaluation (CORE) service, an observation unit for heart failure patients aimed at allieviating ED overcrowding.

“Hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the full-time Project BOOST facilitator at Valley Presbyterian Hospital in Van Nuys. “They see a lot of our patients in their offices.”

Three Valley Presbyterian physicians who work part-time as hospitalists and maintain office practices have agreed to carve out time to see patients who are going home without scheduled appointments with their primary-care physicians (PCPs) within seven days of discharge.

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments,” says Quintero, adding that such patients often decline the hospital team’s offers for help. The readmissions team at Valley Presbyterian is redesigning its clinical multidisciplinary rounds using a rounding script focusing more on discharge planning in rounding.

Larry Beresford is a freelance writer in Oakland, Calif.

Seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, modeled after Project BOOST and sponsored by SHM and the Hospital Association of Southern California (HASC), reported on their experience at a June meeting in Montebello, Calif. Quality teams from four of the seven hospitals demonstrated reductions in readmission rates ranging from 24% to 55%. The other three hospitals are still implementing quality processes and are just now starting to see measurable results.

Several of the participating hospitals do not employ traditional hospitalist services. However, all seven benefit from mentoring by Project BOOST experts and have adopted a number of its approaches and techniques: 72-hour follow-up calls to discharged patients, the use of discharge advocates, medication reconciliation at time of discharge, enhanced discharge planning, and BOOST’s “8Ps” patient risk stratification tool. Another popular approach in use is the “teachback” communication technique, in which patients are asked to repeat in their own words what they understand the professional has told them about their condition and self-care.

One reason many Southern California hospitals do not have a strong hospitalist presence is the widespread prevalence of independent practice associations (IPAs), which often designate members of their medical groups to fill the hospitalist role for patients at a given hospital, says Z. Joseph Wanski, MD, FA

CE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care will be testing the use of hospitalists at some of its contracted acute-care facilities starting in July. (Click here to listen to more of Dr. Wanski’s interview.)

At Harbor UCLA Medical Center in Torrance, a major safety-net facility for Los Angeles County, the readmissions team initially focused on heart failure patients and was able to demonstrate a 5.5% decrease in readmissions for all heart failure patients at a time when readmissions for the hospital as a whole remained the same. The team built relationships with outside partners, including a nearby adult daycare center, home health agencies, and a care-transitions coach while emphasizing early identification of patients for referral to a heart failure disease management registry. The readmissions team also was instrumental in developing the Cardiovascular Open Access Rapid Evaluation (CORE) service, an observation unit for heart failure patients aimed at allieviating ED overcrowding.

“Hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the full-time Project BOOST facilitator at Valley Presbyterian Hospital in Van Nuys. “They see a lot of our patients in their offices.”

Three Valley Presbyterian physicians who work part-time as hospitalists and maintain office practices have agreed to carve out time to see patients who are going home without scheduled appointments with their primary-care physicians (PCPs) within seven days of discharge.

“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments,” says Quintero, adding that such patients often decline the hospital team’s offers for help. The readmissions team at Valley Presbyterian is redesigning its clinical multidisciplinary rounds using a rounding script focusing more on discharge planning in rounding.

Larry Beresford is a freelance writer in Oakland, Calif.

Syed Irfan Ali, MD, a hospitalist at MaineGeneral Medical Center's Thayer Campus in Waterville, recently was honored with the Humanitarian of the Year Award from the Nasreen and Alam Sher Foundation (NASF) for volunteering his medical skills in his native Pakistan.

In November 2011, during a visit to his family, Dr. Ali spent two weekends offering free medical services at Aisha Bibi Memorial Hospital, run by NASF in a village near Karachi. Dr. Ali's uncle heads a pharmacy company in Pakistan and arranged for free medications to be distributed. Approximately 2,100 patients turned up with complaints, such as malaria, typhoid, tuberculosis, lung disease, ear problems, peptic ulcer disease, skin conditions, and gynecologic infections. "Many of these people had never been to a hospital before," Dr. Ali says.

One case that stands out for Dr. Ali was that of a 7-year-old boy who had 15 fractures from a congenital bone condition known to respond to bisphosphonate treatment. Dr. Ali was able to refer the boy to a major hospital in Karachi, where he received the treatment.

"I was trained in family medicine, where you treat people of all ages," says Dr. Ali, who came to the United States in 2004 after completing medical school. "My friends in America, who are working doctors, and I feel we owe a debt to our native country and the people who live there." He started collecting funds for flood relief in 2010 but wanted to do more.

"Now that I've had such an experience, I'd like to go back, and also mobilize my medical friends to get involved," he says.

Chelsea, Maine-based NASF supports health, education, humanities, and peace in South Asian countries. Later this month, Dr. Ali will move to a residency program in anesthesiology at Brigham and Women's Hospital in Boston, but he hopes to return to Pakistan, perhaps at the end of this year.

Syed Irfan Ali, MD, a hospitalist at MaineGeneral Medical Center's Thayer Campus in Waterville, recently was honored with the Humanitarian of the Year Award from the Nasreen and Alam Sher Foundation (NASF) for volunteering his medical skills in his native Pakistan.

In November 2011, during a visit to his family, Dr. Ali spent two weekends offering free medical services at Aisha Bibi Memorial Hospital, run by NASF in a village near Karachi. Dr. Ali's uncle heads a pharmacy company in Pakistan and arranged for free medications to be distributed. Approximately 2,100 patients turned up with complaints, such as malaria, typhoid, tuberculosis, lung disease, ear problems, peptic ulcer disease, skin conditions, and gynecologic infections. "Many of these people had never been to a hospital before," Dr. Ali says.

One case that stands out for Dr. Ali was that of a 7-year-old boy who had 15 fractures from a congenital bone condition known to respond to bisphosphonate treatment. Dr. Ali was able to refer the boy to a major hospital in Karachi, where he received the treatment.

"I was trained in family medicine, where you treat people of all ages," says Dr. Ali, who came to the United States in 2004 after completing medical school. "My friends in America, who are working doctors, and I feel we owe a debt to our native country and the people who live there." He started collecting funds for flood relief in 2010 but wanted to do more.

"Now that I've had such an experience, I'd like to go back, and also mobilize my medical friends to get involved," he says.

Chelsea, Maine-based NASF supports health, education, humanities, and peace in South Asian countries. Later this month, Dr. Ali will move to a residency program in anesthesiology at Brigham and Women's Hospital in Boston, but he hopes to return to Pakistan, perhaps at the end of this year.

Syed Irfan Ali, MD, a hospitalist at MaineGeneral Medical Center's Thayer Campus in Waterville, recently was honored with the Humanitarian of the Year Award from the Nasreen and Alam Sher Foundation (NASF) for volunteering his medical skills in his native Pakistan.

In November 2011, during a visit to his family, Dr. Ali spent two weekends offering free medical services at Aisha Bibi Memorial Hospital, run by NASF in a village near Karachi. Dr. Ali's uncle heads a pharmacy company in Pakistan and arranged for free medications to be distributed. Approximately 2,100 patients turned up with complaints, such as malaria, typhoid, tuberculosis, lung disease, ear problems, peptic ulcer disease, skin conditions, and gynecologic infections. "Many of these people had never been to a hospital before," Dr. Ali says.

One case that stands out for Dr. Ali was that of a 7-year-old boy who had 15 fractures from a congenital bone condition known to respond to bisphosphonate treatment. Dr. Ali was able to refer the boy to a major hospital in Karachi, where he received the treatment.

"I was trained in family medicine, where you treat people of all ages," says Dr. Ali, who came to the United States in 2004 after completing medical school. "My friends in America, who are working doctors, and I feel we owe a debt to our native country and the people who live there." He started collecting funds for flood relief in 2010 but wanted to do more.

"Now that I've had such an experience, I'd like to go back, and also mobilize my medical friends to get involved," he says.

Chelsea, Maine-based NASF supports health, education, humanities, and peace in South Asian countries. Later this month, Dr. Ali will move to a residency program in anesthesiology at Brigham and Women's Hospital in Boston, but he hopes to return to Pakistan, perhaps at the end of this year.