From ICUs to PCMHs: Addressing Quality Across the Continuum of Care

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As healthcare providers we have to address patients' health from the preventive stage to inpatient care to outpatient care. Mercy is working to improve patient safety and quality throughout the continuum of care by focusing on preventable harm and participating in Partnership for Patients, a partnership through the hospital engagement network and CMS to reduce events that harm patients within the hospital. Mercy is also beginning to track chronic disease measures to keep patients healthy and out of the hospital.

Jacalyn LiebowitzPartnership for Patients
We participate in Partnership for Patients in collaboration with Premier health alliance. One of the benefits is Premier's ability to collect and disseminate best practices. In fact, one of the Premier advisors recently went through all our facilities in the northern market to identify where we're doing best practices and where we could implement practices that have been effective in other organizations.

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For example, the Premier advisor shared the best practice of using chlorhexidine to bathe patients in the intensive care unit and provided a guide in transitioning patients out of the hospital. She also suggested we ask patients who are at high risk for falling to sign a contract to use the call button when a need arises instead of getting up.

Chronic disease measures
In addition to measuring quality in the inpatient setting, Mercy is also tracking measures in the outpatient setting, including its 20 patient-centered medical homes. We're currently focusing on the D5 measure for diabetics, which sets the following five goals:
 
1. Blood pressure is less than 140/90 mmHG
2. LDL (bad cholesterol) is less than 100 mg/dl
3. A1c (blood sugar) is less than 8 percent
4. Tobacco-free
5. Take an aspirin as appropriate

Mercy also tracks whether diabetic patients have had an annual eye exam, which is important for preventing diabetic retinopathy. This data is updated daily in physicians' offices, where they can view the data and contact patients who have not met the five measures. In the past six months that we've been tracking the D5, we've seen a 7 percent improvement in patient compliance with these measures.

The fact that we're tracking D5 is pretty significant and is a differentiator for Mercy and Catholic Health Partners. The reality is if we can treat chronic diseases on an outpatient basis and keep patients from getting into a crisis, we can keep them out of a hospital setting. It's easier on the patient and is more cost-effective, because it is cheaper to see someone in an outpatient setting than in an inpatient setting or emergency room.

Jackie Liebowitz is senior vice president, CNO and chief quality officer of Toledo, Ohio-based Mercy, part of Catholic Health Partners.

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