At the 2013 American Medical Directors Association (AMDA) convention in Washington, D.C., speakers from Kindred Healthcare and the Cleveland Clinic presented on acute care to post-acute care relationships. The session highlighted aspects of their own clinical and quality initiatives while giving participants a tutorial in how to get started forming their own collaborations. It is through these types of relationships that health care organizations can work to design and to improve care transitions to meet the challenges of the changing healthcare environment.

Kindred and the Cleveland Clinic began a Joint Quality Committee (a formal and structured relationship) three and a half years ago.  This relationship provides mutual benefits. The acute care hospitals have insight and influence on the care provided to patients after discharge and the post-acute care providers have stronger relationships with the facilities that send the patients.  The beauty of these relationships is that they can be developed with providers, payors and facilities alike.  All you need is willingness to partner, a commitment to patient outcomes across the continuum and an upfront commitment of time and resources for a long-term benefit.

The presentation, titled “Success Through Relationships :  A Guide to Initiating Joint Quality Committees,” offered the opportunity forKindred and the Cleveland Clinic to share their own best practices.  The session encouraged other organizations to work to build relationships in their own markets or skilled nursing facilities. The speakers recommended that participants complete an internal assessment, determine the most beneficial partnering relationships, work to identify aligned goals between the organizations and use a Joint Quality Committee to accomplish the mutual goals.

An infrastructure that promotes successful and lasting relationships includes leadership, physician engagement, communication protocols and complementary clinical capabilities, and above all: tracked and transparent outcomes.

Outcomes tell the story, and the speakers spent a significant amount of time talking about the all-important clinical and patient outcomes measures that organizations can use to track their results.

They included:

  • Internal quality metrics (readmission rates, nosocomial rates, patient satisfaction)
  • External quality indicators (5 star rating, publicly reported measures)
  • Patient reported outcomes (monitoring patient perception of depression, functional status)

Let’s break those down a little.

Organizations were encouraged to look at the data they are currently collecting and how it might be useful in tracking results of partnership efforts. This might include patient satisfaction data, return to level of function at discharge (using  PT and OT data), and discharge disposition– what happens to the patient after he or she is discharged from either or both partner entities.

The most important aspect of sharing data and information is assuring an understanding of the quality and outcome indicators by “speaking the same language.”  This means the definitions and terms used in one setting translate to the other, specifically utilizing the same equations.  Partners must either share or have understanding of each other’s information.

Monitoring performance constantly and tracking the impact of process improvement initiatives are ways to gain a deeper understanding of performance.  The most potent area for organizational collaboration is reducing unnecessary returns to acute care. This can be done by:

  • Physician involvement and availability
  • Clinical competency, confidence and trust
  • Availability of diagnostic testing
  • Candid conversations and realistic communication about current health status
  • Accurate transfer data and medical information for continuity of care
  • Collaborative review of each return-to-hospital case

In summary, consistent measurement of quality and outcome measures; strong working relationships, open, clear communication and a commitment to focusing on key quality outcomes are critically important as organizations move to take the lessons learned by the work being done at Kindred and the Cleveland Clinic and apply them to their own spheres.