FROM: Theodore O. Will, Chief Executive Officer
DATE: December 15, 2009
SUBJECT: Ensuring Patient Readiness for Discharge – A Case Review Based, Beneficiary-Centered, Quality of Care System-Wide Improvement Initiative
IPRO CONTACT: Andrea Goldstein, RN, MS, Vice President, Medicare/Federal Health Care Assessment (phone number 516-209-5364)
In recent months there has been much discussion and many articles published in regard to the need to ensure patient readiness for discharge. Organizations such as AARP (“Chronic Care: A Call to Action for Health Reform”) and the National Quality Forum (NQF Endorsed Definition and Framework for Measuring Care Coordination) concur that times of transition between health care settings are ripe with concerns about quality of care as well as opportunities for improvement. In addition, taking steps to ensure patient readiness for discharge can help mitigate the risk for readmission. In the New England Journal of Medicine article, Re-hospitalizations among Patients in the Medicare Fee-for-Service Program, the authors note that almost one-fifth of Medicare beneficiaries studied, who had been discharged from a hospital, were re-hospitalized within 30 days. (Jencks, Williams and Coleman)
As required by our Medicare 9th Statement of Work (SOW), when quality of care concerns are confirmed as a result of case review activities, IPRO initiates quality improvement initiatives. The Centers for Medicare and Medicaid Services (CMS) defines a quality improvement activity (QIA) as an activity initiated by the QIO that requires:
- An identified provider or practitioner to articulate a plan or activity to improve an identified quality of care concern, and
- The QIO to follow up to ensure that the plan is complete or the action has been taken, and
- The QIO to determine whether the impact of a QIA is system-wide or non-system-wide.
A System-Wide Change QIA is defined by CMS as an activity or change which normally has an impact beyond an individual beneficiary or provider, results in a tangible improvement to a system or process, and improves the quality of health care for Medicare beneficiaries.
IPRO has evaluated our case review data for patterns/trends in regard to 9th SOW, Year One (August 1, 2008 – July 31, 2009) confirmed quality concerns and QIAs. We have identified that many of the issues identified and confirmed through the case review process relate to concerns that impact/can impact a patient’s readiness for discharge as well as increase the potential for readmission. Our findings include such things as failure to address abnormal laboratory results obtained prior to discharge as well as unclear or incomplete discharge instructions.
There are many excellent programs, websites and resources available that offer guidelines, suggestions and quality improvement tools that providers may wish to consider in evaluating their system-wide, interdisciplinary processes that ultimately result in a patient’s discharge. In addition, we have received a number of provider-designed solutions that we would like to be able to share. To accomplish this, we are planning to host a limited series of webinars that focus on quality improvement initiatives that can improve patient discharge as well as to build a complementary community of practice website on JENY.
Details in regard to our first webinar and the JENY community of practice website will be provided in a separate IPRO administrative memorandum as soon as the details are confirmed. Should you have any questions, please feel free to contact Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment at 516-209-5364.