The theme of ICSI’s next colloquium, set for the Saint Paul RiverCentre on May 5-7, 2014, is Building a Sustainable Health System.
Kerri Sparling has been announced as one of our keynote speakers. Ms. Sparling, who has had type 1 diabetes for more than 27 years, is the creator and author of Six Until Me, one of most widely read diabetes patient blogs. Her work as a writer and consultant can be found at diaTribe, dLife, and in diabetes outreach like JDRF’s Countdown magazine.
As many as one in three U.S. adults could have diabetes by 2050, according to the Centers for Disease Control and Prevention. Ms. Sparling will present an engaging patient perspective on how to best meet the needs of this expected tsunami of people living with diabetes. Here is what a past Colloquium Planning Committee Member, Ben Miller, PsyD, Department of Family Medicine, University of Colorado School of Medicine, has to say about Ms. Sparling:
“You want authenticity? You want a challenge? You want to be engaged? If the answer to all three of these questions is ‘yes’ then look no further than Kerri Sparling. Kerri picks an audience up by their lapels and shakes them around convincing them that there is a patient in healthcare who often gets lost and ignored. She reminds us all of the importance of being truly ‘patient-centered’ and dispels any myths that focusing on pieces rather than wholes is a good idea for our health. Very few leaders in healthcare are able to address such complicated issues in healthcare as Kerri; and, she does so with grace, precision, and passion.”
Save the date and watch for more details as the program develops.
A reception with Tom Frieden, MD, Director of the Centers for Disease Control and Prevention (CDC), was held at ICSI in September in conjunction with Dr. Frieden’s visit to our state to learn how Minnesota has achieved the best control of hypertension in the country. Learning Minnesota’s best practices, he noted, might help the CDC and the Centers for Medicare and Medicaid Services reach the goals of their co-led Million Hearts™ Campaign—prevent one million heart attacks and strokes by 2017 through improved clinical and community prevention, and increase the number of persons in the U.S. whose hypertension is under control by 10 million. Learn more.
ICSI brought together more than 60 stakeholders who have been involved with the DIAMOND and SBIRT programs for a learning action forum on September 26, 2013. The “Evolving Integrated Care” forum focused on three areas: celebrating the stakeholders’ accomplishments over the past seven years in integrating behavioral health and primary care; engaging stakeholders on the impact of their work to date and opportunities for improving depression and substance use care in primary care; and exploring innovative strategies to sustain successful integrated care moving forward. Learn more.
The Robert Wood Johnson Foundation (RWJF) has awarded ICSI $150,000 to help promote greater integration of health care systems with public health and other community resources for health improvement. As part of the grant, over the next 18 months ICSI will develop multiple papers, two videos and an assessment tool that support health care system/public health integration. ICSI will also create an advisory committee to provide input and direction for this work.
Learn more about ICSI’s work to build sustainable, healthier communities.
James L. Reinertsen Lecture
Leaders or Victims? Choices We Face in the Era of Accountable Care
October 24, 2013, 4:30 – 6 p.m. Reception, 6 – 7:30 p.m. Lecture
Minneapolis Marriott Southwest, Minnetonka, MN
Plan to join us for an extra-special James L. Reinertsen Lecture, delivered by Dr. Reinertsen himself. One of ICSI’s founders, he will help us celebrate our 20th anniversary and inspire us for the work we tackle during ICSI’s third decade. We expect a large crowd so please help us plan by registering. Find out more and register by October 17.
Shared by The Incidental Economist, an eight-minute video by John Green, a New York Times bestselling author who explains why U.S. health care costs are so high. It’s entertaining and understandable!
Janet Corrigan, PhD, MBA, previous President and CEO of the National Quality Forum, recently led a discussion with the ICSI Board of Directors on efforts to build a value-based measurement framework to help achieve the Triple Aim of better health, better care and better costs.
Helps patients spend 18,280 more nights of sleep in their own beds
A broad-based coalition of hospitals and care providers working across the continuum of care has prevented 4,570 avoidable hospital readmissions between Jan. 1, 2011 and Dec. 31, 2012. As a result of the RARE Campaign (Reducing Avoidable Readmissions Effectively), it is estimated that patients spent 18,280 more nights sleeping comfortably in their own beds instead of the hospital. It’s better for patients and their families. The campaign is also estimated to have reduced inpatient costs by more than $40 million.
The RARE Campaign involves 83 hospitals and 93 community partners across Minnesota and is one of the largest coordinated improvement initiatives undertaken by the Minnesota health care community.
The campaign was initiated to address the fact that in Minnesota, nearly one in five Medicare patients is readmitted within 30 days. According to the Health Research and Education Trust, unplanned readmissions cost Medicare $17.5 billion. “Improving care transitions is part of the Minnesota health care community’s effort to mend the fragmented delivery of care and achieve the Triple Aim of improving population health, the experience of care, and the affordability of care,” said Jennifer Lundblad, president and CEO of Stratis Health, one of the campaign’s operating partners.
The campaign has gathered momentum since its launch. In the most recent time period measured, the 4th quarter of 2012, hospitals achieved a roughly 17 percent reduction in avoidable readmissions compared to baseline. These results are attributed to participants in the RARE Campaign honing their work on five key areas that, if not managed well, are known to be main contributors to avoidable hospital readmissions:
- Comprehensive discharge planning
- Medication management
- Patient and family engagement
- Transition care support
- Transition communications
For example, Swift County-Benson Hospital has achieved success through a combination of interventions including a focus on patient education, increased communication with primary care providers and improved patient transfer communication and collaboration with the area nursing home, assisted living and assisted living plus facilities, and home care agencies. Any time the hospital does have a readmission, staff conducts a thorough assessment to determine the reason for readmission and to identify what could have been done differently before the patient was discharged from the hospital.
At Essentia Health-St. Mary’s Medical Center in Duluth the Nurse Care Line program contacts patients with select diagnoses within 24-48 hours of discharge to answer questions, review medications and discuss the importance of attending scheduled follow-up appointments. The hospital is also working with its community partners including home health agencies, nursing homes and the other hospitals to improve communication across the continuum of care.
Energized by the progress to date, the operating partners have extended the campaign through 2013. “We’re excited about our progress, but we know the improvements can spread even further. We’re challenging ourselves to think beyond the hospital system and beyond a focus on disease-specific efforts,” said Lawrence Massa, president and CEO of the Minnesota Hospital Association. “Hospitals are taking specific steps to ensure a culture that is supportive of collaboration and that supports this readmissions work.”
In 2013, the campaign partners will focus on further engaging community partners beyond hospital walls. Preventing avoidable readmissions requires improved patient care coordination between hospitals and community partners such as long-term care facilities, home care organizations and primary care clinics. In that regard, the RARE Campaign is helping to increase communication and improve care transitions across the health care system.
“In health care today, there is increasing emphasis on the value of care patients receive and rewarding providers for delivering high quality care as efficiently as possible,” said Sanne Magnan, president and CEO, Institute for Clinical Systems Improvement. “The value of the RARE Campaign is that, rather than individual medical associations or hospitals tackling readmissions separately, partners from various health care settings are working together. This collaborative approach enables us to accelerate positive change across Minnesota.”
The RARE Campaign is led by three operating partners: the Institute for Clinical Systems Improvement, the Minnesota Hospital Association and Stratis Health. Supporting partners include the Minnesota Medical Association, MN Community Measurement and VHA Upper Midwest.
To learn more about the RARE campaign, visit www.rarereadmissions.org.
I’ve carried an MD degree proudly for over 40 years. Being of service to those in my community in improving their health has been a badge of pride I’ve worn proudly. But for the 26+ years of practice, and my 11+ years at ICSI, I’ve had the sense we could, and must, do better…. especially as the world around us has changed drastically.
By Thomas Kottke, MD, MSPH and Nico Pronk, PhD
The advances in the treatment of cardiovascular disease in the past 50 years are remarkable. Automated external defibrillators (AEDs), the devices you see in airports and other public places, change out-of-hospital cardiac arrest from a death sentence to an event with some chance of survival. Coronary angioplasty (ballooning the blockages in the arteries that feed the heart) during a heart attack reduces deaths by about 50%. Implantable devices that pace and shock the heart when a life-threatening heart beat occurs reduce the risk of death by more than 40%.1
These statistics and the current emphasis on individualized medicine might suggest that, if a community can afford high tech health care, it doesn’t need to invest in parks, bike ways, tobacco-free homes and workplaces, access to affordable fruits and vegetables, and the other health promoting environments.2 But the data demonstrate that the path to health for every community and every individual, rich and poor alike, requires health-promoting physical and social environments.
Let’s do the math for the high-tech treatments of heart disease and two of the fundamental determinants of health–physical activity and healthy food. The best estimate of what will happen to an individual is what will happen to others in their community. It is simple to calculate the community impact of any intervention if just four parameters are known: (1) the extent to which an intervention will reduce “event rates,” (2) the event rate for eligible individuals who participate in the intervention, (3) the number of eligible individuals who have not yet taken part in the intervention, and (4) the number of people in the community who are eligible for the intervention.
For example, using deaths that might be prevented or postponed (DPP) as “the event,” we can calculate the impact of meeting the physical activity guideline for healthy Americans.
For a population of 30-84 year-old Americans:
- The mortality rate of physically active individuals is 30% lower than the mortality rate for inactive individuals;
- The death rate is 1,007/100,000;
- 70% of those able to be active are currently not active;
- In a population of 100,000, the number of apparently healthy individuals is 90,024.
Therefore, the DPP that could be achieved if the entire healthy population were to become physically active is 0.30 x 0.01007 x 0.7 x 90,024, or 190.
In 2009, we published the expected DPPs for nutrition, physical activity, tobacco and several heart disease treatments.1 We calculated the impact of improving performance from current levels to achieving 100% goal attainment. We found that the number of deaths that might be prevented or postponed in a community of 100,000 adults ages 30-84 would be:
- 1.9 if AEDs were placed in all public places and people who worked there were trained in their use;
- 15.1 if all individuals with heart attacks received angioplasty;
- 63 if all individuals who met the criteria received an implantable defibrillator or biventricular pacemaker;
- 158 if everyone met the dietary goal of five servings of fruits and vegetables every day;
- 159 if no one smoked and no one were exposed to second-hand smoke, and
- 334 if everyone met the physical activity goal of 150 minutes per week.
We found that improving care for acute heart disease events could at most prevent or postpone 8% of deaths in the U.S. population ages 30-84. Taking full advantage of the benefits of good nutrition, adequate physical activity, and elimination of tobacco would prevent or postpone 49% of all deaths. If our calculations considered the impact of all community determinants of health on all ages, the predicted impact would be considerably larger.
It is indisputable that access to medical care saves lives, but the math demonstrates that, regardless of the resources that might be committed to health care, there is only one path to significantly healthier communities. That path is mobilizing action to improve the physical and social environments in which we live.
2. Mobilizing Action Toward Community Health (MATCH): Population Health Metrics, Solid Partnerships, and Real Incentives 2012; http://uwphi.pophealth.wisc.edu/. Accessed December 20, 2012.