August 6, 2019

Kaiser Family Foundation: Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities—A Potential for Achieving Medicare Savings and Improving the Quality of Care

We find that beneficiaries living in long-term care facilities account for a disproportionate share of Medicare spending, with relatively high rates of hospitalizations, emergency room visits, skilled nursing facility admissions and other Medicare-covered services. The relatively high Medicare spending is incurred not only by long-term care residents who die within […]
Read More
We find that beneficiaries living in long-term care facilities account for a disproportionate share of Medicare spending, with relatively high rates of hospitalizations, emergency room visits, skilled nursing facility admissions and other Medicare-covered services. The relatively high Medicare spending is incurred not only by long-term care residents who die within the year, or those who transition from another setting into a long-term care facility, but also by beneficiaries living in a facility throughout the calendar year. Studies indicate that 30 to 67 percent of hospitalizations among facility residents could be prevented with well-targeted interventions.3 Others have identified factors that contribute to preventable hospitalizations, including liability concerns, limited staff capacity, financial incentives, and physician preferences.4 This analysis illustrates how successful efforts to reduce the rate of preventable hospitalizations could yield savings to Medicare. Such efforts, if carefully implemented, could also help to improve the quality of patient care for Medicare’s oldest and most frail beneficiaries.
Read Less
http://www.kff.org/medicare/upload/Presentation-Slides-Jacobson.pdf

August 6, 2019

Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification

Coleman EA, Min SJ, Chomiak A, et al. Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification. Health Serv Res. 2004;39(5):1423-1440. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/ . Accessed August 7, 2014. Principle Findings: 46 distinct types of care patterns were observed during the 30 days following hospital discharge. Among these patterns, 444 episodes (61.2 percent) […]
Read More
Coleman EA, Min SJ, Chomiak A, et al. Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification. Health Serv Res. 2004;39(5):1423-1440. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/ . Accessed August 7, 2014. Principle Findings: 46 distinct types of care patterns were observed during the 30 days following hospital discharge. Among these patterns, 444 episodes (61.2 percent) were limited to a single transfer, 130 episodes (17.9 percent) included two transfers, 62 episodes (8.5 percent) involved three transfers, and 31 episodes (4.3 percent) involved four or more transfers. 59 episodes (8.1 percent) resulted in death. Between 13.4 percent and 25.0 percent of post-hospital care patterns in the 1998 sample were classified as complicated. The area under the receiver operating curve was 0.771 for a predictive index that utilized administrative data and 0.833 for an index that used a combination of administrative and self-reported data. Conclusions: Post-hospital care transitions are common among Medicare beneficiaries and patterns of care vary greatly. A significant number of beneficiaries experienced complicated care transitions – a finding that has important implications for both patient safety and cost containment efforts. Patients at-risk for complicated care patterns can be identified using data available at the time of hospital discharge.
Read Less
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/

August 6, 2019

National Transitions of Care Coalition

National Transitions of Care Coalition (NTOCC). [Web site]. Http://www.ntocc.org/Home.aspx . Updated 2014. Accessed July 29, 2014. The National Transitions of Care Coalition is a 501©(4) organization dedicated to addressing a serious U.S. health care issue: filling the gaps that occur when patients leave one care setting and move to another […]
Read More
National Transitions of Care Coalition (NTOCC). [Web site]. Http://www.ntocc.org/Home.aspx . Updated 2014. Accessed July 29, 2014. The National Transitions of Care Coalition is a 501©(4) organization dedicated to addressing a serious U.S. health care issue: filling the gaps that occur when patients leave one care setting and move to another care setting. These transitions include patients moving from primary care to specialty physicians; moving or transferring patients from the emergency department to intensive care or surgery; and when patients are discharged from the hospital to home, assisted living arrangements, or skilled nursing facilities. The U.S. health care system often fails to meet the needs of patients during these transitions because care is rushed and responsibility is fragmented, with little communication across care settings and multiple providers. Since 2006, NTOCC’s Advisors Council of over 30 organizations has shared a common goal of improving the quality of Transitions of Care. Working in conjunction with 450 Associate Member organizations and over 3,000 individual professional subscribers, NTOCC has developed tools and resources made available to everyone in the health care industry including providers, payers, patients and consumers. NTOCC’s mission is supported by the Partners Council made up of innovative companies leading critical change in health care coordination.
Read Less
Http://www.ntocc.org/Home.aspx

August 7, 2019

The Joint Commission National Patient Safety Goals

During 2009, the National Patient Safety Goals underwent an extensive review process. As a result, The Joint Commission has revised the NPSGs. The changes were made partly in response to concerns from the field about the resources needed to comply with NPSGs that have become more specific and detailed over […]
Read More
During 2009, the National Patient Safety Goals underwent an extensive review process. As a result, The Joint Commission has revised the NPSGs. The changes were made partly in response to concerns from the field about the resources needed to comply with NPSGs that have become more specific and detailed over time. The revisions include clarifying and streamlining certain elements of performance, as well as deleting some requirements and moving others to the standards. The changes to the NPSGs reflect The Joint Commission’s continuing efforts to focus the NPSGs on those topics that are of highest priority to patient safety and quality care. Decreasing the number of NPSGs allows organizations to focus their efforts on the most important issues. Moving a requirement to the standards means that it is no longer necessary to “spotlight” the issue in the NPSGs. The improvements are similar to the Standards Improvement Initiative (SII), which the standards have undergone, and the goal of the improvements is to clarify language and ensure relevancy to the settings in which they apply. 2011 NPSG # 8: Accurately and completely reconcile medications across the continuum of care.
Read Less
http://www.jointcommission.org/standards_information/npsgs.aspx

August 7, 2019

TJC Sentinel Event Alert: Using medication reconciliation to prevent errors

The Joint Commission recognizes that many patients may be too ill, injured, young, or disabled to actively participate in the medication reconciliation process. In addition, patients may need the assistance of another person (e.g., family member, significant other, surrogate decision maker) if they are overwhelmed in managing their condition, are […]
Read More
The Joint Commission recognizes that many patients may be too ill, injured, young, or disabled to actively participate in the medication reconciliation process. In addition, patients may need the assistance of another person (e.g., family member, significant other, surrogate decision maker) if they are overwhelmed in managing their condition, are not proficient in speaking or reading English, or face health literacy challenges that might prevent them from understanding medication use directions. Therefore, the following addition should be included in the section titled "Joint Commission requirements and recommendations." Addendum to Sentinel Event Alert #35, Using medication reconciliation to prevent errors (#4) When the patient is unable to actively or fully participate in the medication reconciliation process and has requested assistance from another person(s) (e.g., family member, significant other, surrogate decision maker), involve the authorized person(s) in the medication reconciliation process. This involvement should occur at all interfaces of care, and on admission to and discharge from the facility.
Read Less
http://www.jointcommission.org/assets/1/18/SEA_35.PDF

August 7, 2019

Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century

This is the second and final report of the Committee on the Quality of Health Care in America, which was appointed in 1998 to identify strategies for achieving a substantial improvement in the quality of health care delivered to Americans. The committee’s first report, To Err Is Human: Building a […]
Read More
This is the second and final report of the Committee on the Quality of Health Care in America, which was appointed in 1998 to identify strategies for achieving a substantial improvement in the quality of health care delivered to Americans. The committee’s first report, To Err Is Human: Building a Safer Health System, was released in 1999 and focused on a specific quality concern—patient safety. This second report focuses more broadly on how the health care delivery system can be designed to innovate and improve care. This report does not recommend specific organizational approaches to achieve the aims set forth. Rather than being an organizational construct, redesign refers to a new perspective on the purpose and aims of the health care system, how patients and their clinicians should relate, and how care processes can be designed to optimize responsiveness to patient needs. The principles and guidance for redesign that are offered in this report represent fundamental changes in the way the system meets the needs of the people it serves. Redesign is not aimed only at the health care organizations and professionals that comprise the delivery system. Change is also required in the structures and processes of the environment in which those organizations and professionals function. Such change includes setting national priorities for improvement, creating better methods for disseminating and applying knowledge to practice, fostering the use of information technology in clinical care, creating payment policies that encourage innovation and reward improvement in performance, and enhancing educational programs to strengthen the health care workforce.
Read Less
http://www.nap.edu/openbook.php?isbn=0309072808

August 7, 2019

Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors: Quality Chasm Series

In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation s quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the series To Err […]
Read More
In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation s quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the series To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004) this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.
Read Less
http://www.nap.edu/catalog.php?record_id=11623#description

August 7, 2019

Consecutive Medicare stays involving inpatient and skilled nursing facilities

In this OIG report, medical review of consecutive stay sequences revealed instances of problems with quality of patient care and fragmentation of health care services across multiple stays. Physician reviewers’ examination of medical records for consecutive stays sequences enabled the reviewers to analyze and identify the broader impacts of quality-of-care […]
Read More
In this OIG report, medical review of consecutive stay sequences revealed instances of problems with quality of patient care and fragmentation of health care services across multiple stays. Physician reviewers’ examination of medical records for consecutive stays sequences enabled the reviewers to analyze and identify the broader impacts of quality-of-care problems and fragmentation of services beyond the level of an individual inpatient stay.
Read Less
http://oig.hhs.gov/oei/reports/oei-07-06-00340.pdf

August 7, 2019

NTOCC Policy Considerations: Improving Transitions of Care

Learn which policy considerations NTOCC believes are important to better transitions of care.
Learn which policy considerations NTOCC believes are important to better transitions of care.
Read Less
http://www.ntocc.org/Portals/0/PolicyConsiderations.pdf

August 7, 2019

Aging and Disability Resource Center (ADRC) Development and LTC Options

The Aging and Disability Resource Center Program (ADRC), a collaborative effort of AoA and the Centers for Medicare & Medicaid Services (CMS), is designed to streamline access to long-term care. The ADRC program provides states with an opportunity to effectively integrate the full range of long-term supports and services into […]
Read More
The Aging and Disability Resource Center Program (ADRC), a collaborative effort of AoA and the Centers for Medicare & Medicaid Services (CMS), is designed to streamline access to long-term care. The ADRC program provides states with an opportunity to effectively integrate the full range of long-term supports and services into a single, coordinated system. By simplifying access to long-term care systems, ADRCs and other single point of entry (SEP) systems are serving as the cornerstone for long-term care reform in many states.
Read Less
http://www.aoa.gov/AoAroot/AoA_Programs/HCLTC/ADRC/index.aspx