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Creating Care Transitions That Reduce Readmissions and Improve the Health of Communities

February 3, 2013
by Mark Hagland
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Jane Brock, M.D., of Colorado’s QIO discusses the challenges and potential in community-based care transition interventions

On Jan. 23, leaders at the American Health Quality Association (Washington, D.C.) held a press briefing to highlight the publication of an article in the Journal of the American Medical Association (JAMA) in which leaders in AHQA documented an impressive decline in hospitalization and rehospitalization among Medicare patients in communities in which Quality Improvement Organizations (QIOs) have coordinated interventions that engaged whole communities in care improvement. The JAMA article, entitled “Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries,” was authored by six healthcare researchers, including lead author Jane Brock, M.D., MSPH, chief medical officer at the Colorado Foundation for Medical Care, that state’s QIO.

As Dr. Brock and Joanne Lynn, M.D., M.A., M.S., a fellow study leader and article co-author, noted during the press briefing, 14 communities participated in the study; all 14 were communities in which QIOs had become involved in community-wide healthcare improvement efforts. Those communities participating in the study saw an average 5.7-percent reduction in rehospitalizations and a 5.74-percent decrease in initial hospitalizations during the same two-year period. The core innovation involved, Drs. Brock and Lynn, and Mary Ellen Dalton, R.N., Ph.D., noted, was the success of QIOs in working with coalitions of stakeholder groups within individual communities to create consensus-driven interventions to improve care delivery.

The 14 communities involved in the project were: Tuscaloosa, Ala.; Denver, Colo.; Miami, Fla.; Atlanta, Ga.; Evansville, Ind.; Baton Rouge, La.; Lansing, Mich.; Camden, N.J.; Albany, N.Y.; Pittsburgh, Pa.; Providence, R.I.; Harlingen, Tex; and Whatcom County, Wash. Within those communities, the researchers found that quality improvement interventions were associated with about 6,800 hospitalizations and 1,800 rehospitalizations averted per year.

Dr. Brock spoke shortly after that press briefing with HCI Editor-in-Chief Mark Hagland regarding her participation in the study, and her organization’s efforts more broadly. Below are excerpts from that interview.

Can you tell us about the origins of the program and of the study that led to the JAMA article?

CMS [the federal Centers for Medicare & Medicaid Services] creates its  national quality strategies, and issues a single core contract for each state and territory; and the QIOs are essentially companies or agencies that hold the QIO contracts. And when officials at CMS have an appropriate project, they release it for certain types of contractors to bid on. So they had released a contract for two special studies in 2006-2008, and we at the Colorado QIO had received both contracts. One was to recruit hospitals to target any elements of non-beneficial utilization, and to undertake a 15-month, four-state project, to reduce that utilization. The second study was given to Colorado to see if the care transitions intervention could be applied. The leading evidence-based intervention is called the Care Transitions Intervention, or CTI, and Eric Coleman [Eric A. Coleman, M.D., M.P.H., professor of medicine and head of the University of Colorado School of Medicine’s Division of Health care Policy and Research, and creator of the Care Transitions Intervention]

 is at the University of Colorado, right around the corner from us. And the purpose of the second study was to see if ordinary providers could be recruited into a care transitions project, and thereby improve readmissions. We got both contracts the same day and combined them. And New Jersey and California were two states involved. And about 18 hospitals decided to work on ICU [intensive care unit] utilization at the end of life. In Colorado and New Mexico, those hospitals decided to focus on readmissions. And CMS allowed us to put the hospitals in Colorado and New Mexico into both projects, meaning that we could use resources to feed them data.

Jane Brock, M.D., MSPH

So hospitals in Colorado and New Mexico were involved in both? And hospitals in New Jersey and California were only involved in the non-beneficial utilization project?

That’s exactly right. Especially in Colorado, we recruited the hospitals to participate in an effort to reduce readmissions, and fed utilization data back to them, and then also got them involved in the second project.

Were the Colorado hospitals the most comprehensive in their approach?