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RARE - Reducing Avoidable Readmissions Effectively

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RARE Report - October 2013

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RARE Report

The RARE Report updates participating hospitals and Community Partners on news and events related to the RARE Campaign, demonstrates how hospitals and Community Partners can work together across the continuum of care, shares best practices, and provides tools to keep all stakeholders engaged and implementing improvements to achieve RARE goals. Please send your feedback to: Mary Beth Schwartz.

Previous Issues

In This Issue

  1. Upcoming Events and News
  2. Rapid-Adoption Methodology Boosts Hospital Quality Improvement and Reduces Avoidable Readmissions
  3. Improved Transition Communications at CentraCare Health – Sauk Centre Help Reduce Avoidable Readmissions

Upcoming Events and News


Details and registration for all events listed below are available on the calendar page of the RARE Campaign website.

RARE Webinar: Beyond ‘Engagement’ – Family Caregivers as Partners in Preventing Readmissions
Wednesday, October 30, 2013, Noon – 1 p.m. CT
Learn about the New York United Hospital Fund’s Next Step in Care campaign to routinely involve family caregivers in planning, decision making, and coordinating care, particularly around transitions from one care setting to another. Registration closes October 28. Learn more.

Join Us at the Next Action Learning Day!

Monday, November 11, 2013, Plymouth, MN

Mark Williams
Mark Williams
Victor Montori
Victor Montori

Don’t miss this opportunity to share with and learn from other statewide RARE participants working on similar readmission topics. This educational/ networking event will focus on improving care transitions and reducing avoidable readmissions. The keynote speaker is Mark V. Williams, MD, FACP, MHM from the Society of Hospital Medicine and Project BOOST (Better Outcomes for Older Adults Through Safe Transitions). Victor Montori, MD, director of the Health Care Delivery Research Program at the Mayo Clinic in Rochester, MN, will deliver the closing address. Registration closes November 4. Cost is $40 per person, including continental breakfast and lunch. Contact hours will be available. Learn more.

St. Cloud Hospital Transitions of Care Program Honored with Innovation Award
St. Cloud Hospital’s Transitions of Care program has been selected as recipient of the 2013 Innovation I-Award by the Center for Nonprofit Excellence and Social Innovation (CNESI) Board of Directors. Read the October 1, 2013 news release.

Essentia Health Earns Top Accreditation
Duluth-based Essentia Health is one of two health systems in the country to be recognized as having reached the highest level of providing cost-effective, comprehensive care to patients. One example is its heart failure program in Duluth, which according to the most recent data, has a 30-day readmission rate of 7-10 percent compared to a national rate of 20-25 percent. Read article in October 10, 2013 Duluth News Tribune.

More Community Partners Lend Support to the Campaign
Welcome to three Minnesota organizations that recently joined the RARE Campaign as Community Partners: Amherst H. Wilder Foundation, St. Paul; Home Instead, Maplewood; and Gentiva, Roseville. See the complete list.

Join the RARE Collaborative on Mental Health Care Transitions
The RARE Collaborative: Mental Health Care Transitions is a yearlong learning collaborative for organizations with inpatient mental health units. It is designed to support organizations in reducing readmissions for these patients and to improve their transition into post-acute care.

Using best and promising practices as well as evidence-based interventions, each organization’s team will be coached through the process of improvement. Content will focus on the five key areas known to reduce avoidable readmissions, with a concentration on the mental health population. Participating organizations will be able to network with other participants as well as learn from national experts.

The collaborative will primarily use virtual meetings with a daylong session at the beginning and end of the year. A kick-off call is planned for Tuesday, January 14 and the first learning day will be on Wednesday, February 19, 2014.

We are recruiting five to seven organizations to join the collaborative. If you are interested in participating, or would like more information, please contact Kathy Cummings at 952-814-7086 by November 15, 2013.


Variation in Surgical-Readmission Rates and Quality of Hospital Care
Reducing hospital-readmission rates is a clinical and policy priority, but little is known about variation in rates of readmission after major surgery and whether these rates at a given hospital are related to other markers of the quality of surgical care. (New England Journal of Medicine, September 19, 2013)

Continuity of Care and the Risk of Preventable Hospitalization in Older Adults
This study demonstrated that among fee-for-service Medicare beneficiaries 65 and older, higher continuity of ambulatory care is associated with a lower rate of preventable hospitalization. (JAMA Internal Medicine, September 16, 2013)

VHA logoRapid-Adoption Methodology Boosts Hospital Quality Improvement and Reduces Avoidable Readmissions

VHA Upper Midwest is a RARE Supporting Partner

VHA Upper Midwest supports and collaborates with statewide initiatives, like the RARE Campaign, in conjunction with VHA’s Hospital Engagement Network (HEN). Now in its second year, this clinical improvement collaborative, sponsored by the Centers for Medicare and Medicaid Services (CMS) Partnership for Patients Initiative, is helping nearly 200 hospitals across the U.S. reduce hospital-acquired conditions to make patient care safer. Through its 26 HEN sites, CMS aims to identify solutions already working and disseminate them to other hospitals and providers at the regional, state, national or hospital system level with the goal of reducing nine preventable conditions by 40 percent and avoidable readmissions by 20 percent. Of the 200 organizations participating in VHA’s HEN, 19 hospitals of various sizes are supported by VHA Upper Midwest.

RAN workflow
Visual of RAN Process

The organizations participating in VHA’s network receive intensive training, peer-networking, clinical support and leading practices resources derived from its nearly 30 years of working with not-for-profit hospitals on clinical improvement programs. What is unusual about VHA’s approach is its Rapid Adoption Network (RAN) methodology. Based on anthropological research, VHA’s approach emphasizes context so that each hospital’s set of solutions fits their unique culture and existing process to make change more natural and sustainable. The methodology offers a step-by-step process which enables organizations to identify and understand specific obstacles and find solutions to overcome them. The process brings physicians, nurses, and other clinical team members together and gives them the skills to design and implement improvements in their own clinical practices.

The VHA HEN hospitals were asked to select two to four preventible conditions and/or readmissions to use with the RAN metholodology. We found that hospital teams using RAN are showing improvements that are in some cases dramatic compared to those using other methods. For example, for readmissions, the performance improvement shown by hospitals using RAN (48 hospitals) is currently 27 percent. For non-RAN hospitals (74 hospitals), the corresponding performance improvement in readmissions is 0 percent. These patterns appear in many but not all of the areas of focus, so VHA is currently evaluating why and in what circumstances the methodology leads to better performance.

To date, VHA has trained 100 percent of its HEN hospitals – or more than 800 clinicians – on its methodology in addition to supporting engagement through site visits, moderated networking calls and monthly coaching.  The VHA method has provided hospitals the opportunity to talk to their peers about what is working and what is not. Each of the hospitals that participated in VHA’s HEN across the country has made lasting changes that benefit patients and their communities by improving care, and reducing avoidable readmissions.

For more information, contact Deb Brown.

CCH Sauk Centre logoImproved Transition Communications Helping Reduce Avoidable Readmissions

As CentraCare Health – Sauk Centre worked to implement its electronic medical record (EMR) system, the hospital recognized it as an opportunity to improve the flow of information for care transitions. Transition communications is one of the five key areas known to reduce avoidable readmissions.

“Our journey to reduce readmissions began with our involvement in the Safe Transitions of Care program,” said Sue Winges, RN, quality coordinator, infection control preventionist and utilization review nurse at CentraCare Health – Sauk Centre. “One of the first things we did was work with our adjacent nursing home and the other nursing homes in our area to develop a safe transitions form for Epic (the organization’s electronic medical record).”

The hospital’s RARE Committee, comprised of the social worker, nurses, an IT representative, the health care home nurse and Winges, led this work. They focused on making sure all the correct information was being communicated – where the patient is going, who accepted them, etc. – and that it could be documented in the EMR. They also conducted staff education on why it is important to include specific information and to ensure it is available to the nursing home upon the patient’s arrival. According to Winges, part of their success in reducing readmissions has come simply from increasing awareness of the importance of proper discharge planning and communication. The hospital also has placed an emphasis on making sure the right people are at the table, including the health care home nurse who will coordinate follow-up care.

CentraCare graph CentraCare Health – Sauk Centre’s ratio of actual readmissions to expected readmissions improved from 0.87 in 2009 to 0.53 in the first quarter of 2013 (see graph), a 39 percent improvement and well below the RARE Campaign’s goal. While there have been a few dips and spikes, overall it has been a steadily downward trend for the past year.

Continuing to move the needle
In examining its data, CentraCare Health – Sauk Centre discovered that readmission rates were highest among patients with chronic obstructive pulmonary disease (COPD). “We are now focused on how to reduce readmissions for these patients,” said Winges. “Specifically, COPD medication compliance is now the focus for us.” 

The hospital also initiated a project to ensure all nurses know how to administer nebulizers and inhalers so they can instruct the patient on proper use. “We realized we couldn’t educate the patients on how to take their meds if the nurses themselves don’t know the proper way to use them,” explained Winges. The hospital has enlisted the help of a pharmacy student who is helping lead the project. The health care home nurse is also included so she can confirm that patients are taking their medications correctly once they leave the hospital. Moving forward, the hospital hopes to develop a COPD control plan similar to asthma control plans that have proven successful.

For additional information, contact Sue Winges at (320) 351-1754.

The RARE Report is brought to you by the RARE Campaign’s Operating Partners: Institute for Clinical Systems Improvement, Minnesota Hospital Association and Stratis Health, with contributions by the campaign’s Supporting Partners, Minnesota Medical Association, MN Community Measurement and VHA Upper Midwest.

If you have any questions related to the content of the RARE Report, contact:

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RARE is a campaign lead by the Institute for Clinical Systems Improvement, the Minnesota Hospital Association, and Stratis Health, which represents Lake Superior Quality Innovation Network in Minnesota.