NMMRA Articles

Published In: Southwest Senior, August 2007

Reduce Avoidable Hospitalizations - With Help

By Sheila Conneen and Christine Beechhold 

Each year older Americans who are Medicare beneficiaries, experience over 1.1 million hospitalizations. The financial cost of these inpatient hospital stays is more than two billion dollars a year, but the human cost is great for many seniors. Even brief hospital stays often mean they will need to spend weeks regaining their strength and their ability to manage as safely and independently at home as they did before hospitalization. Annually, nearly three million elderly Medicare participants receive home health care to support them as they deal with complex, chronic illness; more than a quarter of these seniors will be hospitalized while they are receiving care at home. Although many of these hospitalizations are unavoidable, successful collaboration among home care patients, their families, home health agencies, physicians, and hospitals can significantly decrease unnecessary hospitalizations and help seniors stay where most of them want to be - at home.

It may not take a village but it surely takes a committed team to make home care safe and effective. That team includes not only an agency's nurses, physical, speech, and occupational therapists, social workers, and home health aides but, most of all, the patient and, often, one or more family caregivers. In January, 2007, recognizing the importance of these collaborations, national leaders from the Centers for Medicare & Medicaid Services (CMS), the National Association for Home Care and Hospice (NAHC), the American Physical Therapy Association, the American Telemedicine Association, and many other national and state-based organizations, including New Mexico's Medicare quality improvement organization (QIO), the New Mexico Medical Review Association (NMMRA), launched the Home Health Quality Improvement (HHQI) National Campaign. This voluntary campaign is a 12-month interdisciplinary approach aiming to unite the home health community nationwide with a shared vision to reduce avoidable hospitalizations and to improve the quality of care and health outcomes for home health recipients. The campaign's involvement of other community partners, including managed care organizations, pharmacies, and nursing homes also reflects the complex, interdisciplinary, and interdependent nature of home care.

The national response to this campaign has been strong with over 5500 agencies committing to participate. New Mexico's commitment to participation has been overwhelmingly positive. Thus far, 63 of New Mexico's 66 Medicare-certified home health agencies or 95 percent have joined the campaign, and participation is still growing. Campaign members are enthusiastic about the opportunity to be part of a nationwide effort aimed at accelerating quality improvement in home health care homes. Speaking for her organization's members statewide, Joie Glenn, executive director of the New Mexico Association for Home and Hospice Care (NMAHHC), notes, "We are thrilled to be part of this cooperative initiative with home health agencies, NMMRA and our state association. Since we've begun this process, I have seen home health agencies increase their productivity, efficiency, and quality of care. Their initial enthusiasm to participate in this challenging campaign remains and has indeed grown beyond our expectations as we walk together on this journey."

As a campaign participant, each agency receives monthly best practice intervention packages tailored to the needs of all disciplines in the agency, including administrators, nurses, therapists, social workers and home health aides. These intervention packages include tools and resources for home health staff and patients, evidence-based guidelines, patient self-care information and examples of successful practices used by high-performing agencies. In addition, agencies are provided with customized benchmarking reports that show their actual monthly hospitalization rates, comparing their performance with state and national rates. These reports also contain breakdowns of the reasons for patients' hospitalizations by diagnoses and risk groups.  These analyses provide valuable information to aid agencies in developing quality improvement interventions to identify and better serve patients at high risk for hospitalization.

The national campaign relies on Local Area Networks for Excellence (LANEs) to disseminate this information and encourage participation at the local level.  In support of the HHQI campaign in New Mexico, NMMRA and NMAHHC have been working together as the state's LANEs to help agencies maximize the benefits of their participation in the campaign. These efforts include conducting regional learning sessions throughout New Mexico to help agencies use their data reports and best practice intervention packages to identify opportunities for optimizing the care they provide. During learning sessions, agencies assess their current health care practices, identify areas for improvement, develop action plans, and incorporate discipline-specific modules into staff education programs. Throughout the campaign, NMMRA and NMAHHC will provide leadership support, technical assistance, and agency-specific resource materials.

"It is exciting for NMMRA's home health team to see the response of New Mexico's home health agencies to this campaign. Our state's home health community has a long history of working intensively on quality improvement activities tied to improving the outcomes of the care they provide to their patients," said Sheila Conneen, RN-C, home health quality improvement manager at NMMRA and a former home health agency administrator. "Now the campaign's interventions bring together proven strategies to support effective care at home and make it easier for patients, families, home health agency staff, physicians, and hospitals to work together to reduce avoidable hospitalizations and help keep patients safe and independent at home."

For more information about the HHQI National Campaign, visit http://www.homehealthquality.org/ or http://www.nmmra.org/providers/homehealth.php.  Additional information about New Mexico's LANE activities may be obtained by calling Sheila Conneen, at (505) 998-9757 or via e-mail at sconneen@nmmra.org.

Sheila Conneen, PhD, RN-C, is NMMRA's home health quality improvement manager. She is a certified adult nurse practitioner and has worked in acute care, home health, and long-term care for over 30 years.

Christine Beechhold, MA, is a communications specialist with NMMRA, working on the nursing home and home health teams. She has over 10 years experience in health care communications and media relations.