El Camino Hospital sits in what would appear to be an enviable position for a health care facility -- squarely in the middle of the Silicon Valley, near San Francisco. It's not shocking that the community hospital is fairly advanced when it comes to the use of IT.
But when the 443-bed acute care facility looked to tackle patient readmissions, IT made its contribution by playing a supportive role, assisting researchers in making better decisions and helping caregivers communicate more effectively. Through the combined use of data analytics and advanced telecommunications, El Camino Hospital has seen a dramatic reduction in readmissions through its initiatives.
IT initiatives don't play flashy roles as part of the hospital's wider strategy to reduce patient readmissions. However, El Camino Hospital's experience shows how IT can provide effective tools to enable a health care provider to meet a community's overall needs. The hospital's initiatives are profiled in a recently released case study by the College of Healthcare Information Management Executives (CHIME), an Ann Arbor, Mich.-based professional organization.
For example, in the area surrounding Mountain View, Calif., the hospital is planning to expand a program to optimize transitions of care and ongoing communication with post-acute care providers that frequently receive discharged patients who aren't completely healed but no longer need acute care services.
The hospital's efforts are paying off. In the first three months of 2013, typically a challenging quarter for readmissions for elderly populations, the hospital saw a 4.7% seven-day readmission rate among the 584 patients discharged to skilled nursing facilities. By contrast, over the same three months in 2012, the hospital's readmission rate was 6.2% among 526 patients discharged to SNFs.
Vision of the Organization
Initiatives to reduce readmissions mesh with a broader vision of the hospital's board of directors to offer more value-based care, according to Eric Pifer, chief medical officer for El Camino Hospital. "We have a broad scope of services as a hospital, but we're also trying to make inroads to better coordinate care in the community," he said.
Efforts to improve communication with area SNFs make sense because they receive a great share of frail patients from El Camino Hospital, and these recovering patients are at risk for suffering medical setbacks that might require a return to the hospital. By continuing to monitor these patients' conditions in a collaborative fashion, some readmissions can be prevented.
"A lot of players in the continuum play a significant role in the treatment and recovery of a patient, and yet they are starving for data and connectivity," Greg Walton, CIO at El Camino Hospital, said. "These skilled nursing facilities in our area have been so gracious and receptive to our efforts, but they are downstream from us and always struggling to get better information from us. We're using telehealth to have connectivity with them after discharge."
Technology Improves Communication
Specifically, El Camino Hospital is using telepresence -- essentially high-quality two-way videoconferences between the hospital and a long-term care facility -- to provide a conduit for exchanging information and continuing hospital involvement in post-discharge care. "Nurses that are caring for that patient in the nursing home now feel like they are connected to their patient and also to the prior caregiver," Walton said. "They realize that someone is paying attention to the patient's status post discharge."
For its part, El Camino Hospital has created a transition team that includes a nurse practitioner, a care coordinator and others as needed; the long-term care facilities pull together nurses, administrators, social workers and others who are interacting with discharged patients and their families. The telepresence program started last July, and Walton says two long-term care facilities now have telepresence meetings with El Camino Hospital staff, and the hospital is currently in the process of adding two more.
"Having these meetings face-to-face really changes the dynamic of the interaction," said Mae Lavente, the nurse practitioner who is the hospital's point of contact for questions on discharged patients and participates in all the telepresence meetings. "I used to work in an SNF, so I know how they operate, and I understand where they're coming from when they have a question."
"If they have some questions that need to be asked, we can always look it up on [the hospital's] electronic chart in real time. It's really a discussion between us, so if (nursing home staff) says something and I wasn't thinking of it before, I can react. It's better than a phone call -- it's having a personal interaction. You pick up visual cues from what you see when you talk to them."
Analysis of Data Yields Readmission Clues
As El Camino Hospital sought to reduce readmissions, its experience has shown that successful transitions in care depend on beginning discharge planning as soon as possible, especially for those patients who are at highest risk for readmission. The facility's research, based on its own historical patient data, is able to identify these high-risk patients early in their hospitalization -- typically, immediately after admission -- and alert everyone providing care about the risk.
El Camino Hospital took the data from 10,000 patients hospitalized in 2010 and did a regression analysis of 25 characteristics about patients that the hospital would know the day after admission, according to Pat Kearns, medical director of El Camino Hospital's Senior Health Center. It developed a formula to predict readmissions, and in 2011, it applied the formula to a validation group.
Kearns said it was able to identify groups at low, moderate and high risk for readmission -- rates for those groups ranged from 1% for the low-risk group to 11% for the moderate-risk group and 27% for the high-risk group. Predictors of readmission that El Camino Hospital found in the study included:
- The patient's age;
- Where the patient was to be placed after discharge;
- Five particular diagnoses (congestive heart failure, pneumonia, stroke, sepsis and renal failure); and
- Whether the patient's primary care physician was identified in the patient's active medical record.
A banner across each patient's electronic health record communicates readmission risks to all care team members. Overall, stratification of readmission risk, and acting on that knowledge to intervene with patients most likely to be readmitted, has resulted in a 25% reduction in El Camino Hospital's readmission rate. "We think that demographic information is very powerful in predicting the potential for readmission," Kearns said.
El Camino Hospital is pursuing several other efforts through its Avoiding Readmissions Coalition, such as developing a standard transfer checklist and verbal handoff report on key patient issues, and further refining identification of patients at high risk for readmission.
More benefits will be gained as additional providers participate in these efforts, and as financial incentives push providers to give better care, not just higher volumes of care, Walton and Pifer say. "We need distributed care management systems that collect information on [aging] patients and warn us when they begin to veer off the path," Pifer added. "It will take a combination of personal health records, together with people who can use that information to manage populations."