Suffering from heart failure, Eddie Malleis, 73, had been at the University of Colorado hospital for 13 days. All he wanted to do was go home.
But first, Colleen McIlvennan, a clinic nurse specialist in the hospital's advanced heart failure unit, needed to review his discharge instructions. Did Mr. Malleis understand which new medications he was taking and why? Did he know which ones he should continue taking and which he should stop?
Sitting on the edge of his hospital bed, silver-haired and lean, Mr. Malleis answered yes to all of the nurse's questions. But he hinted that he might not remember everything she was telling him: "When I go to the pharmacy, they'll have all this written out on the bottles, right?"
Ms. McIlvennan assured him that they would and handed him a five-page summary of what he needed to know when he went home. Included was information about a follow-up appointment scheduled within the week and a number for that physician. Was this the number to call if he had any questions after leaving the hospital? It wasn't clear; there were several phone numbers on the sheets, but none of them were highlighted.
Of all conditions that land people in hospitals, heart failure is the one that most commonly causes older adults to bounce back within 30 days. It's one of three conditions that Medicare is concentrating on as it pushes to reduce readmissions by 20 percent and imposes financial penalties on hospitals with higher-than-average readmissions rates.
Hospitals like the University of Colorado have responded by studying why heart failure patients return to the hospital and what can be done to improve their transition back home. Hundreds of medical centers are testing strategies that revolve around several themes:
- Spend more time teaching patients and caregivers about how to manage this condition.
- Assess what kind of support they may need (assistance with transportation, meals delivered to the home, home health care) when they go back into the community. Help make those connections.
- Follow up after patients leave the hospital, either by phone or in person, and deal with concerns they might have.
- Make sure patients are seen by their primary care doctor within a week, and forward an account of what happened in the hospital to those physicians.
- Let patients know who is responsible for coordinating their care and what to do if that provider is not available.
Turn this around, and you have some idea of what older adults and their caregivers should expect on discharge from a hospital. But many medical centers fall short of delivering some or all of these strategies. And almost none have involved patients in planning how to prevent readmissions, raising the risk that patients' needs are not being addressed.
One initiative that has incorporated patient input is the Care Transitions Program, used by 850 providers across the country and directed by Dr. Eric Coleman, head of the division of health care policy at the University of Colorado, Denver.
"What we've learned from patients is that no one seems to be in charge" of their care, he said. "We don't ask patients or their families to articulate their goals. We don't work from a single medication list. We can't seem to coordinate our efforts. And we don't see and overcome barriers to self-care," like low literacy and impaired cognition.
How should seniors and caregivers respond? "When you leave the hospital, you become by default your own care coordinator," Dr. Coleman said. "The more you can do to assert that role and tell health professionals what you really need, the better."
To start, insist that a family member or caregiver be at your side when hospital staff give you instructions about what to do when returning home. "Hospitals discharge patients at their convenience, with a few exceptions," Dr. Coleman said. "Make it very clear you don't want this to happen."
Do not leave the hospital until you have answers to these questions: "Why was I in the hospital? What was done to me? What needs to happen going forward? What should I be doing to maintain a stable condition?" said Dr. Christopher Manasseh, a researcher at Project RED, or Re-Engineered Discharge, at Boston University Medical Center.
Ideally, conversations about how to deal with heart failure — watching your weight, cutting back on salt, getting exercise, changing your diet, following medication regimens — should begin early in a hospital stay and be reinforced daily, Dr. Manasseh said. If nurses are not giving you this kind of information, tell them you want it.
Do not be shy about letting medical providers know about your life outside the hospital and your expectations for the future. Do you live alone or with someone? Were you functioning well or becoming impaired? Do you have a way to get to medical appointments, get up the stairs, shop for groceries? Do you think you might need some extra help?
"The focus needs to change from the hospital's priorities to your priorities, what you need to get back to the life you were living," said Beth Ann Swan, dean of the school of nursing at Thomas Jefferson University in Philadelphia.
When Dr. Swan's husband, Eric, was discharged from a rehabilitation hospital in 2011 after a brain stem stroke, she took home 29 pages of information about seven medications he had been prescribed, a 10-page report on five medical experts he needed to see post haste, and five pages of instructions about home safety.
"There was just too much information to absorb," Dr. Swan wrote in an article describing the harrowing experience. "No one reviewed it with us to be sure we understood it all — or at least the key points."
"It's unbelievable what we're sending people home to do," often without assessing their capacity or the resources they have available, said Robyn Golden, co-founder of the National Council on Care Coordination and director of health and aging at Rush University Medical Center in Chicago.
Ms. Golden helped developed a program known as the Bridge Model, which calls for social workers to coordinate post hospital discharge care for older adults and caregivers. They link seniors as needed to community organizations that can provide various kinds of nonmedical assistance.
Hospital staff may ask you to set up an appointment with your primary care doctor within a week or do this for you. Even if you don't understand why you need to see another doctor at this time — and many patients don't — make sure you go, Dr. Coleman said. Outside the hospital, this doctor is responsible for monitoring you and dealing with medical problems that might arise.
It's frequently hard to get in to see medical specialists on a timely basis. If this happens to you, ask your contact at the hospital or your primary care doctor to make a call on your behalf to try to help you get in sooner.
And don't forget to use this catchphrase, suggested by Ms. Golden: "I hear there's a big concern about people coming back to the hospital unnecessarily. How can you help me make sure that doesn't happen?"
Anda sedang membaca artikel tentang
The New Old Age Blog: More on Preventing Hospital Readmissions
Dengan url
http://healtybodyguard.blogspot.com/2013/07/the-new-old-age-blog-more-on-preventing.html
Anda boleh menyebar luaskannya atau mengcopy paste-nya
The New Old Age Blog: More on Preventing Hospital Readmissions
namun jangan lupa untuk meletakkan link
The New Old Age Blog: More on Preventing Hospital Readmissions
sebagai sumbernya
0 komentar:
Posting Komentar