I don’t know how to handle this Health & Medical question and need guidance.
RE: Discussion – Week 11
Week 11 Main Response
Innovations in Healthcare
One of the challenges of modern healthcare systems is how to scale, spread, and sustain innovations that deliver value to healthcare. Great ideas don’t always make it beyond local pilots and can fizzle out over time as the creators move on to other ideas or other organizations (Zelmer, 2015). There are times when change in healthcare is frustratingly slow, with promising innovations that are blocked by a variety of roadblocks or stuck as local gems that fail to benefit those in other areas (Zelmer, 2015). But it is not true that all innovations fail to grow and deliver value beyond the context in which they were first introduced. Studying these successful experiences can be at least as instructive as learning from the failures (Zelmer, 2015). This discussion will be a review of one innovation with an explanation of the innovation, the outcome, and how a similar innovation could be beneficial in my organization.
The innovation I selected was a pharmacy driven program to improve medication compliance and management. This innovation was located from Agency for Healthcare Research and Quality website as an innovation listed from 2016. The Managing Your Medications (MyRx) Medication Adherence Program offered culturally and linguistically tailored medication management and health education to seniors with hypertension and/or diabetes living in the community. The program consisted of pharmacists that made visits to the participants in their homes, to perform a medication assessment and reconciliation, offer personalized education, and develop a care plan. The plan also included two sessions hosted by health educators for a group session that focused on healthy eating and then a session on physical activity and stress management. The program resulted in increased participants’ knowledge about diabetes and hypertension, improved medication adherence, and observed significant reductions in blood pressure. The program’s impact on hemoglobin A1c levels and weight were inconclusive. The program ended when grant funding diminished. The total budget for the program was approximately $280,000, including payments to pharmacists and the student translator, the cost of materials, incentive payments to participants ($15 each), and research-related expenses.
Introducing Similar Innovation
When I read the above article on the innovation idea, my mind was swarming with ideas. From the hospital setting, lack of compliance and medication management is one of the primary reasons for readmissions. The Centers for Medicare and Medicaid Services (CMS) has penalties for preventable readmissions that could total $528 million (Walker, 2016). A study conducted by the Agency for Healthcare Research and Quality (AHRQ) on readmissions from 2011 identified congestive heart failure as the top cause of readmissions among Medicare patients, followed by septicemia, pneumonia, COPD and cardiac dysrhythmias (Walker, 2016). Several factors that increase the likelihood of readmission may be modifiable, especially those that relate to clinician or system level issues including adverse drug events and other medication related issues (Alper, O’Malley & Greenwald, 2020).
We implemented through the case management department, a transitional coach program. This program involves the transitional coach making a visit to certain high-risk patients prior to their discharge and then within the first week, a transitional coach call and a home visit. No care is provided during the home visit, but they do discuss the discharge instructions, discharge med list, and follow-up appts. Frequently, the home visit results in other needs being identified and resources discussed and/or initiated with the patient. Medication discrepancies and noncompliance seems to still be one of the primary findings. This program has resulted in improvement in follow-up visits being kept after discharge. With the innovation in mind that was reviewed, the transitional coach visits could be made with a pharmacist also. This could identify additional needs which could be lack of knowledge or misunderstandings about the medications ordered, and the education from the pharmacist could address those needs.
Part of the issue with the MyRx program was the costs. The criteria used to identify the high-risk patients are those with minimal or no pay source, new to the area, and do not qualify for other ongoing services such as home health services. The cost of the transitional coach addition has been far less than the benefits to the facility. The outcome has been beneficial to the facility in regards to a decrease in readmissions or at least an increased time period between admissions with some patients. Currently, the transitional coach consists of one full time position. The transitional coach program has been in place for over two years and still ongoing. Adding a pharmacist to the home visits may result in even more reductions. To implement, once the costs of the use of the already present hospital staff is approved for a trial, the criteria could be set to determine which patients are higher risk for medication mishaps that could determine which visits would be shared with the pharmacist. Keeping statistics on the readmission rates, the reasons for readmission, and the length of time between admissions, as well as interventions of the pharmacists and evaluation feedback from the patients can be monitored to assess the impact.
Healthcare leaders must often times think outside the box in order to solve issues in healthcare. Often time times, leaders don’t have to go to far outside the box if they look for innovations already in progress. Why re-create the wheel? Learning lessons from others can be useful by looking at the failures and successes. With the advantages of technology in our current time, sharing ideas is even easier than in the past. With a carefully planned, coordinated and implemented process, organizations can effectively spread their quality improvement interventions, sometimes employing and transferring the processes for identifying and implementing changes.
Agency for Healthcare Research and Quality (2016). Culturally Tailored Pharmacist Home Visits and Educator-Led Group Sessions Increase Medication Adherence and Reduce Blood Pressure for Seniors with Hypertension and Diabetes. Retrieved from https://www.innovations.ahrq.gov/profiles/cultural…
Alper, E., O’Malley, T. A. & Greenwald, J. (2020). Hospital discharge and readmission. Retreived from https://www.uptodate.com/contents/hospital-dischar…
Walker, B. (2016). The Top 5 Causes of Hospital Readmissions – and How to Prevent Them. Retrieved from https://insights.patientbond.com/blog/the-top-5-ca…