What are care management’s best practices at this early stage in its existence? This question was answered by William Mills, MD, Chief Medical Officer for Kindred at Home and Vice President of Medical Affairs for Kindred’s new Division of Care Management, during a break-out session at Kindred’s Fifth Annual Clinical Impact Symposium.
There’s no doubt that readmissions to acute care hospitals are costing the healthcare system a lot of money, and the patients who cost the system the most might fit a profile like this:
Patients like this typically see anywhere from two to ten doctors regularly. They have no home support, so when a crisis arises, 911 is called and the patient is taken to the emergency room, which leads to a hospital stay eight out of ten times, Dr. Mills said. Rehabilitation and a long-term care stay follow, then home care and then the cycle recurs.
For patients like this, wouldn’t it make more sense to deliver care in the home setting?
Although the posters at Kindred’s Clinical Impact Symposium came from different Kindred facilities and covered different topics, the one thing each had in common was the passion and enthusiasm of the people presenting the projects and information.
While the posters were filled with technical terms and acronyms, the patient was never forgotten and there were often pictures of patients surrounded by their care teams, many having defied the odds for a successful outcome. While it wasn’t possible to cover all of the presentations, we had a chance to talk to the people behind three of them.
Our fictitious patient, Jack, has developed severe diarrhea and is being treated with metronidazole. He is in a skilled nursing facility for wound care and rehabilitation. The diarrhea is not improving and oral vancomycin is started for suspected C. Diff infection. Stool cultures have been sent out.
The stool culture comes back positive for CRE, or Carbapenem Resistant Enterobacteriaceae.
Ruth Carrico, PhD, RN, Associate Professor, Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, led participants at the Fifth Annual Clinical Impact Symposium through the next steps of infection control for our patient, Jack.
Carrico first questioned participants about whether, given his situation, Jack should be isolated. The answer? Yes.
“We must assume that a body fluid out of control is caused by something transmissible until proven otherwise,” she said.
Effective, efficient movement of patients through the post-acute continuum of care is Kindred’s goal. But infectious diseases are unwelcome visitors that also like to make the post-acute continuum of care their home, starting in the acute care hospital and settling in at the various levels of post-acute care settings.
Addressing issues related to infectious diseases today at Kindred’s Fifth Annual Clinical Impact Symposium was Alice Kim, MD, Director of Infectious Disease/Control at Kindred’s Cleveland Fairhill Hospital.
Dr. Kim, who came to Kindred from the Cleveland Clinic with the mission of implementing acute-hospital devised infectious disease plans in the post-acute setting, described the challenges related to infectious diseases in both acute and post-acute care.
NOTE: The following care story is purely hypothetical and was crafted specifically for 2013 Clinical Impact Symposium attendees to use as an exercise in care transitions. Any resemblance to a person living or deceased is coincidental. Future CIS posts may refer back to this fictitious story for reference.
Stacey Seggelke, sees patients with diabetes both in and out of the hospital, and shared her experiences at the Kindred Clinical Impact Symposium. She is a member of the inpatient Glucose Management team at the University of Colorado Hospital and has an outpatient diabetes clinic one day per week.
There has been a steady and significant increase in diabetes over the last 30 years. It affects 8 percent of the population, and it is estimated that there are 79 million people who are pre-diabetic. Even when it is not the primary diagnosis, diabetes impacts the care provided to the person, and Seggelke works with her patients from admission to discharge to make sure that the treatments for other medical issues don’t harm the patient or cause problems related to their diabetes.
Did you know that a pharmacist invented Coca Cola? This was just one interesting fact divulged by Kindred Hospital Division Vice President of Pharmacy James Poullard, who presented this afternoon at Kindred’s Fifth Annual Clinical Impact Symposium.
For Coke lovers, this fact makes pharmacists critical. But more importantly, pharmacists play a crucial role in effective care transitions.
Pharmacy – the science and technique of preparing and dispensing drugs and medicines – has undergone a transformation over the years, according to Poullard.
“We’ve gone from pouring sodas and mixing elixirs to now being the medication expert in retail outlets, and in the inpatient arena,” he said. “There are now post-graduate residency programs and we’ve become an integral part of the patient care team.”
And pharmacists have their work cut out for them.
Representatives from each of Kindred’s divisions – the Hospital Division, the Nursing Center Division, Kindred at Home, RehabCare and the Care Management Division – demonstrated ways in which Kindred clinicians and staff across the enterprise can collaborate to improve care transitions throughout the country during a presentation at the Fifth Annual Clinical Impact Symposium.
Kindred Clinical Impact Symposium speaker Dr. Eric Coleman challenged attendees at the event to step out of their comfort zones to really look at what it means to say, “We are patient-centered” or “We are involved in patient engagement.”
The key is to focus on what patients want for themselves, not just on what providers want for them, he said. Caregiver involvement is also vital.
Dr. Coleman is the founding director of The Care Transitions Program, a national program that aims to improve quality and safety at times of transition across settings for patients. This is his second year speaking at the symposium.
Kindred Chief Executive Officer Paul J. Diaz and President and Chief Operating Officer Benjamin A. Breier addressed participants at Kindred’s Fifth Annual Clinical Impact Symposium by painting a portrait of where Kindred is now, and where the company is going over the next several years, as the American healthcare landscape continues to change.
“We are seeing rapid change in the way healthcare is delivered in this country,” said Diaz. Delivering high quality, low-cost care, reducing rehospitalizations and adapting to new payment models that focus on a patient’s entire episode of care are the orders of the day.
As the nation’s largest diversified provider of post-acute care services, Kindred, which cared for over half a million patients last year alone, is well-positioned to meet these challenges.
Diaz outlined Kindred’s three general goals:
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