Quality Today
Primaris produces QualityTODAY, the premier source of healthcare quality improvement news in Missouri. QualityTODAY is published quarterly, sent to approximately 5,000 healthcare professionals and leaders statewide. E-mail Matt Heger (mheger@primaris.org) to get your copy or for reprint information.
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FALL 2006 |
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Remaking American Medicine Hits Primetime
Starting in October 2006, two primetime television documentary series will air on Missouri PBS stations challenging our notions of how medicine works, how it could be better and why it must transform. The four-part series, Remaking American Medicine, and a local spinoff, Remaking Missouri Medicine, take a hard look at issues such as medical errors, both investigating the causes of these challenges and illuminating the innovations that may provide solutions.
The national Remaking American Medicine presents an intelligent, fair and straightforward examination of challenges facing the medical industry. The series delves into patient safety, medical and medication errors, hospital-acquired infections, family-centered care and chronic disease management. But rather than assign blame for failings of the U.S. system of health care, the series showcases the individuals and institutions that are finding ways to ensure its improvement.
“We wanted to present detailed and emotionally engaging profiles of people like Dr. Donald Berwick, founder of the Institute for Healthcare Improvement (IHI), who are struggling to fix our broken health care system. Remaking American Medicine is their story, told through the eyes of doctors, nurses, administrators and patients, showing their strengths, their setbacks and their victories,” said Frank Christopher, executive producer.
Each piece of the Remaking American Medicine series is an hour long.
Program One, “Silent Killer,” investigates the estimated 98,000 fatal medical errors made each year in hospitals and the Institute of Medicine’s “100,000 Lives Campaign.”
Program Two, “First Do No Harm,” further explores patient safety and the fight against hospital-acquired infections through the efforts of two hospitals, following the efforts of physicians who are challenging their colleagues to live up to their oath to “first do no harm.”
Program Three, “The Stealth Epidemic,” examines the human and economic costs of effectively managing diabetes, heart disease and other chronic conditions that currently consume 70 percent of all health care resources.
Program Four, “Hand in Hand,” rounds out the series
with a look into patient-centered care. As the systems that
deliver medical care become increasingly complex, the
relationship between providers and patients and families
is more important than ever. This final
installment observes how a
teaching hospital in Augusta,
as a partner with patients and
families.
The Missouri Connection
In support of the Remaking American Medicine project, Primaris partnered with KETC/Channel 9, the multiple-Emmy Award-winning public broadcasting station in St. Louis, for a companion series. That documentary grew into Remaking Missouri Medicine.
“Our goal in creating Remaking Missouri Medicine is to inspire and empower people to join in efforts to improve the quality of health care in their own communities,” said Amy Shaw, Vice President of Education at KETC/Channel 9. "Quality health care is one of those critical issues that impact every person at every level of society, and we saw this throughout the filming of the project.”
“Remaking Missouri Medicine has given us a chance to
step back, look at our health care system and say ‘We
are doing well, but where could we be better?’” said
Richard A. Royer, Primaris CEO. “Only through an
open and analytical look at our systems of care can
we hope to make significant improvement. This series
gives us that chance.”
The documentary series presents stories of
physicians, providers and patients working together
to fundamentally improve health care safety and
quality. KETC/Channel 9 crews toured every corner of
Missouri finding the accounts in Remaking Missouri
Medicine. The shows are designed to inspire and
empower viewers, as well as look deeply at the state’s
route toward better resources and care for the entire
Show-Me State.
That route has some bumps. In fact, during the course
of the filming, an agency exemplifying quality care
was closed due to changing priorities of its
parent organization. The closure further demonstrated
the challenges constantly facing health care.
Program One, “Improving Patient Care in Hospitals,”
focuses on the surgical infection prevention program
at St. Louis’ Barnes Jewish Hospital and the
transformation of the 40-bed Sac-Osage Hospital in
Osceola.
Program Two, “Chronic Disease Management,” looks at how advances in information technology help manage chronic diseases, both within physician offices and through home monitors and other “telehealth” options. Featured in the program are Tom Landholt, M.D. and the Kansas City Visiting Nurse Association.
Program Three, “Caring for the Elderly,” shows two progressive facilities for seniors who need assistance: the former Red Cross Adult Day Care facility in South St. Louis and Timberlake Care Center, a newly redesigned nursing home in Kansas City.
Program Four, “Access for All,” explores efforts to provide access to quality health care to underserved populations. Featured efforts include filling the gap of a closed hospital in St. Louis city, Dr. Scott Turner serving rural Missouri, and a Washington University pilot program in which medical students teach kids in low-income neighborhoods about health.
Originally airing across the entire state in April 2006, Remaking Missouri Medicine’s four programs are each half an hour in length and constructed as a prequel to the national program. While the original April broadcast was carried on all Missouri PBS stations, not all stations will carry the October rebroadcast. Check your local listings. Where available, Remaking Missouri Medicine will precede Remaking American Medicine.
Remaking Missouri Medicine Guide to Quality Healthcare
Healthcare has a topography all its own. For a patient, being dropped into this foreign, ever-shifting environment
can feel like being inserted into the jungles of Venezuela. Add to that a broken leg. They’re lost, they don’t know
the language and they’re in pain. What they need most is a map.
Starting in October, two primetime television documentary series will air on Missouri PBS stations challenging our notions of how medicine works, how it could be better and why it must transform.
The four part series, Remaking American Medicine, and a local spinoff, Remaking Missouri Medicine, take a hard look at issues such as medical errors, both investigating the causes of these challenges and illuminating the innovations that may provide solutions.
With this in mind, Primaris developed the Remaking Missouri Medicine Guide to Quality Healthcare. The Guide covers the basics of being a patient, disease management, senior care options and resources in Missouri in an easy-to-read, easy-to-carry, portable format. Now all they need is a compass!
Request Free Copies!
Copies are available at no cost while supplies last.
Order them online.
Taking Control of Acute Care Hospitalizations
Every care setting impacts the quality of other care settings.
This quarter, even Mother Nature is affecting a Medicare home
health measure: Acute Care Hospitalization.
Storms that ripped through St. Louis in late July cut power to
over a half million homes and businesses. Next came triple
digit temperatures. Predictably, the percentage of seniors
needing emergency care jumped. Ventilator patients and
cardiac patients on dopamine drips via infusion pumps lost
needed electricity. Patients on oxygen ran out of back-up
emergency tanks and fragile patients without air conditioning
deteriorated in the heat.
The situation demonstrates part of the complexity of the Acute Care Hospitalization (ACH) measure, which is used to judge quality of home health agencies. Theoretically an effective home health agency can curtail the necessity of expensive, preventable hospital visits through measures such as reducing falls, and so the Centers for Medicare & Medicaid Services has set the ACH as a priority. However, as St. Louis proved in July, many determining factors are out of their control.
Despite nature’s fury, Missouri’s health care community can reduce unnecessary hospitalizations. Providers must take advantage of the strengths of the entire team or, in this case, the entire health care continuum. Home health services give hospitals and physicians unprecedented ability to help ensure patient compliance, improve disease management and proper medication administration, and monitor the safety of their environment. The key to utilization is efficient communication.
The idea behind ACH is to keep patients from returning to the hospital so often that it seems as if they’re stuck in the lobby’s revolving doors. Hospital processes must be in place to ensure:
- Premature discharges are avoided
- Descriptive written information is provided (care instructions, updated medication list, follow-up information such as lab tests or other appointments)
- Home health agencies are consulted regarding discharge in time to make necessary arrangements to meet the patient’s care needs
Providing a smooth transfer back to home life will greatly
decrease the chance of a preventable future hospitalization. Physicians also play a vital role in reducing unnecessary
hospitalizations. Several steps can simplify both the physician
and home health agency’s role. These include:
- Providing PRN or standing orders to allow home care to respond before a patient’s condition deteriorates
- Promptly responding to home health agency communications
- In non-acute situations, considering an urgent home health visit instead of referring the patient to the emergency department
At the same time, good communication must be reciprocated.
Home care agencies must do their part by providing
hospitals and physicians with pertinent and complete
information on patients.
Paring down wasteful hospitalizations is more than entirely
possible; it is necessary. Taking full advantage of home health
services is a big step in that direction.
Tis the Season
It’s flu and pneumonia time again. For nursing homes, offering influenza and pneumonia shots is now federally mandated. But as Sue Denny, Influenza Coordinator for the Missouri DHSS, said “That’s one little piece and there are many little pieces, especially when you’re talking about adult immunizations.”
These other pieces – health departments, home health agencies, hospitals, physicians and more – all play a key role in holding the flu and pneumonia at bay. Beyond getting out the needles, what can you do to ensure more adults get the protection they need?
Here are some tips:
Tell Your Friends!
While doses of vaccine don’t always arrive in a timely manner, that doesn’t mean education shouldn’t. Remind every senior you see about flu and pneumonia vaccines!
- Promote flu and pneumococcal vaccination to patients through posters and other informational materials.
- Stress the potential flu and pneumonia complications, particularly for patients with diabetes or chronic lung or heart problems.
Encourage Documentation
- Use easy-to-find immunization notations in charts, preferably in a separate immunization card or,
better yet, in an electronic health record. - Encourage patients to retain immunization records – the Missouri Department of Health and Senior Services offers record cards for free (Order IMMP-1 and IMMP-BAG). See below for ordering instructions.
- Patients can join the voluntary Missouri registry at their local health department. The state will then retain a record of immunizations through this growing program. Similar registries in Mississippi and Louisiana have proven invaluable in the wake of Hurricane Katrina, Denny said.
Around the Water Cooler
- Make office-wide changes such as chart sticker prompts or, if possible, in standing orders (now allowed in hospitals!). Screen every high-risk patient.
- Set goals and keep track of the number of patients vaccinated weekly; create a “kick-off” lobby display to keep up interest.
- Are you vaccinated? Are your coworkers?
Reminders Work!
In 2001, both influenza and pneumonia immunization rates were dropping among Missouri’s Medicare population. To combat this, starting in fall 2002, Primaris and the Missouri Immunization Coalition sent patient reminders to randomly selected beneficiaries in 30 counties. During three years, over 150,000 reminders were sent statewide. These reminders proved successful.
Since then, each year has seen improved rates over the previous year with greater improvement in selected counties. By 2004, both rates had climbed to their highest point this decade. Pneumonia immunization rates increased among Missouri Medicare beneficiaries, improving twice as quickly as national levels. Consider initiating a similar localized campaign.
Free DHSS Resources
A listing is available here: http://www.dhss.mo.gov/Immunizations/Literature.html.
Fax in this Order Form: http://www.dhss.mo.gov/warehouse/580-039.pdf.
For ordering assistance,
call the DHHS immunization team at (573) 751-6124.
Beneficiary Assistance Program Goes Local
In a move to increase access to Medicare assistance, CLAIM, the state health insurance assistance program (SHIP), amplifies its local presence across Missouri.
For over a decade, CLAIM has provided no
cost, one-on-one counseling to Medicare
beneficiaries. The program, composed
of a network of volunteers and partner
organizations, has saved beneficiaries over
$8 million since its inception. CLAIM played
an integral role in assisting tens of thousands
enroll in the new Medicare Prescription
Drug Program.
Previously, CLAIM has worked through a strong central office in Columbia. Though the program will remain centered there, an increased presence will be placed in each of seven regions across the state.
“This strategy will strengthen our collaborative of more than 50 partner organizations and over 200 volunteers across the state. They are the heart of our program,” said Carol Beahan, Director of the CLAIM program. “The goal is to bring the program closer to the people we serve.”
Medicare Questions?
Call CLAIM: 800-390-3330