Home health visits being redefined

Hospitals are working more proactively in forging relationships with the next-level-of-care providers, the experts say. "We're working with home health agencies and skilled nursing facilities to design agreements that help clearly define the transition process," Donna Zazworsky, RN, MS, CCM, FAAN, vice president for community health and continuum care at Carondelet Health Network in Tucson, AZ, says. "With home health agencies, we expect our patients to be seen within 24-48 hours post-discharge."

This immediate home health visit sometimes is necessary for step-down care, and it also ensures the discharge plan is being followed. Hospitals no longer can assume patients will follow through on discharge plans once they return home, she adds. "Our experience now tells us they don't," Zazworsky says. "It's not because they don't want to, but they might not have the support system to get their medications for several days, which ends up with them returning to the hospital."

Beverly Cunningham, MS, RN, vice president of clinical performance improvement at Medical City Dallas Hospital in Dallas, TX, says when home health care and other providers are not part of the major payer groups that serve the hospital's patients, the hospital will encourage payers to contract with the providers. "We encourage payers by saying, 'This is a company that is good; we have seen as we track them that they don't have a lot of readmissions and are really focused on managing the patient outside of the hospital,'" she says. "Then we tell the providers, 'So why don't you work together and get a contract so you can take our patients?'"

These kind of efforts might accomplish some of the same benefits and reductions in readmissions that ACOs are designed to do. Some hospitals might choose to continue their own efforts before committing to an ACO, she says. "We're not jumping into an ACO endeavor, but we're aggressively looking at readmissions and that next-level-of-care provider," Cunningham explains. "We feel if they go to that provider, they won't bounce back to the hospital."

Medical City Dallas Hospital also uses mid-level practitioners to manage high-risk patient populations. These include a heart failure nurse practitioner who identifies high-risk patients who are at risk for readmission, she says. "We have wellness clinics for them," Cunningham says. "We identify the people who will be the most difficult to manage, and we assure their transition is appropriate and at the right level of care."

This effort has been going on for a few years, but the healthcare reform bill has encouraged the hospital to improve and to become better organized, she adds.

"Healthcare reform has forced us to be better than we are," Cunningham says.

Codes add value to patient education

Smartphone users are beginning to use a device called a "barcode scanner" that allows them to open Quick Response (QR) codes. These codes are found on a multitude of items including magazine ads, signs, business cards, and museum graphics, says Fran London, MS, RN, a health education specialist at The Emily Center, a family health library at Phoenix (AZ) Children's Hospital.

Anyone with a barcode scanner on their phone can read the code by putting it in the telephone camera's view, she explains. The scanner takes the smartphone user to the link associated with the QR code, which can be anything from a web site URL to a Google map location. (For more details on QR codes, see the source, below.)

According to London, there are web sites that can be used to create a QR code for free. Just search for "QR Code generator," she instructs. Once a QR code is established, it can be included on a teaching handout, for example. When the code is scanned, it might connect to a video that demonstrates the self-care skill for an area such as a dressing change, London explains.

While the QR code is not a way to communicate essential information to patients and their families, it is a free tool that facilitates interaction, she emphasizes.

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