罗伯特·伍德·约翰逊基金会授予210万美元赠款,以改善护理,降低最昂贵患者的成本
The Foundation has awarded $200,000 to each of six organizations that operate quality improvement alliances in RWJF’s Aligning Forces for Quality (AF4Q) initiative, which serves as the Foundation’s signature effort to lift the overall quality of health care and provide models for national reform in 16 targeted communities across the United States.
Grant recipients include AF4Q alliances that serve Boston; Cincinnati; Cleveland; Humboldt County, Calif.; Maine; and Western Michigan. These regions have all made great strides to improve the quality of care delivered to patients overall in their areas. Now, they are tackling the additional challenge of improving care and reducing unnecessary costs and spending for super-utilizers in the system.
The grants are based on the successful work of Jeffrey Brenner, MD, founder and executive director of the Camden Coalition of Healthcare Providers (CCHP), which set out to improve the quality and cost of health care delivery for super-utilizers in Camden, N.J. RWJF previously awarded Brenner and the coalition $900,000 to provide technical assistance to each project.
“Like every community nationwide, these six communities have health care hot spots where the most complex patients overuse emergency rooms and drive up the overall cost of care in large measure because they do not get the coordinated care, both medical and social, that they need,” says Susan Mende, BSN, MPH, RWJF senior program officer. “The AF4Q alliances are the right groups to develop and implement effective models to meet the needs of super-utilizers outside the emergency room. Each community’s patients and needs are different, so this program will help us learn what works best in a variety of settings, so we can provide models for others to replicate.”
Today’s grant is a natural extension of RWJF’s investment in CCHP, which began in 2005. The six alliances will work to review hospital records to identify super-utilizers in their areas. Typically, these are patients with multiple chronic medical problems and social complexities.
The goals of the pilot programs are to keep patients healthy, and improve the quality of care they are receiving, including coordinating social and medical interventions. The program will also reduce unnecessary costs by identifying alternatives to hospital admissions that will reduce hospital readmission rates and unnecessary ED visits.
Specifically, the six alliances will work directly with CCHP and Brenner to create a network of needed medical and social services through care teams that serve the patients directly, referring patients to super-utilizer clinics and working with primary care practices. The alliances will provide coaching and support for local physicians to enable targeted care and case management for the super-utilizer patients.
“This grant creates a great opportunity to not only help the neediest, most expensive patients in these communities, but to learn how to take this work to scale,” says Brenner. “This is a national challenge, but it can only be solved one community at a time.”
Grant Recipients
Massachusetts Health Quality Partners (Greater Boston)
Greater Boston Super-Utilizer Pilot Project
This project will leverage a pilot community-based team program (Healthy Lives) that has shown initial success at improving quality outcomes and reducing costs for super-utilizers through a combination of active engagement, care coordination, and wellness activities. The model will be expanded by adding a part-time case manager to focus on helping connect patients to neighborhood-based social services and consumer and faith-based organizations.
The Health Collaborative (Cincinnati)
ED Care Coordination Pathway Program Pilot
This project will leverage an existing ED care coordination program to develop a pilot community-based outreach team. The team will include a community health worker (lead) and AmeriCorps volunteers to coordinate services and support patients through a network of medical, social service, and behavioral health services. A multi-disciplinary clinical advisory team of social workers, hospital case managers, physicians, and behavioral health staff will oversee the patients’ care.
Better Health Greater Cleveland
Red Carpet Care for Patients in Greatest Need: The Greater Cleveland Super-Utilizer Project
This project will develop super-utilizer “clinics-within-clinics” in two National Committee for Quality Assurance level-3 certified patient-centered medical homes in Cleveland. The clinics will be staffed by interdisciplinary care teams and will partner with 10 area hospitals to identify and monitor super-utilizers in the community. The clinics will also partner with a prominent faith-based organization to connect patients to non-medical support.
Aligning Forces Humboldt
Care Coordination for Emergency Department Super-Utilizers
This project will develop a community-based team through a collaborative effort between two existing, successful programs (the Care Transitions Program and Priority Care) that provide case management and nurse-led care coordination. The most distinctive aspect of this proposal is the rural setting in which the project will operate, which will provide important insight for developing super-utilizer models in similar settings.
Maine Quality Counts
Maine Patient-Centered Medical Home Pilot – Developing a Vanguard
This project will enable Maine’s statewide Community Care Team (CCT) super-utilizer program to select and develop one of its current CCTs to be a “Vanguard” team to serve as a model for informing the future of the program. The existing CCT program consists of eight community-based, multi-disciplinary super-utilizer teams that work with PCMH pilot practices to identify high-need patients who would benefit from additional multi-disciplinary care management support.
Alliance for Health (Western Michigan)
Systematic Identification and Care of High-Frequency Emergency Department Utilizers
This project will leverage an existing super-utilizer care clinic in Kent County, growing the clinic’s reach into a multi-hospital model. They will develop a HIPAA-compliant interaction between all Kent County EDs and clinics via the local health insurance exchange.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.ottomotal.com. Follow the Foundation on Twitter www.ottomotal.com/twitter or Facebook www.ottomotal.com/facebook.
About Aligning Forces for Quality
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, as well as reduce racial and ethnic disparities and provide real models for national reform. The Foundation’s commitment to improve health care in 16 AF4Q communities is the largest effort of its kind ever undertaken by a U.S. philanthropy. AF4Q asks the people who get care, give care and pay for care to work together to improve the quality and value of care delivered locally. The Center for Health Care Quality in the Department of Health Policy at George Washington University School of Public Health and Health Services serves as the national program office. Learn more about AF4Q at www.forces4quality.org.
" data-isabstract="false" class="cmp-text">新泽西州普林斯顿大学罗伯特·伍德·约翰逊基金会(RWJF)今天宣布通过一项新的倡议拨款210万美元,旨在解决医疗保健中最棘手的问题之一:所谓的“超级利用率”患者过度使用我们国家的急诊科和医院住院服务。美国的医疗支出分布不均,5%病情最严重的患者花费了60%以上的医疗费用。
医学博士阿图尔·加万德(Atul Gawande)在一篇文章中强调了“超级实用者”的《纽约客》去年,频繁返回急诊室(ed)或多次住院。医院服务通常是治疗这些患者最昂贵和最低效的方式,医院的过度使用对整体医疗保健系统改革构成了重大挑战。
基金会已向在RWJF的质量协调力量(AF4Q)倡议中运营质量改进联盟的六个组织各奖励了20万美元,该倡议是基金会提高医疗保健整体质量的标志性努力,并为美国16个目标社区的国家改革提供了榜样。
赠款接受者包括为波士顿服务的AF4Q联盟;辛辛那提;克利夫兰;加州洪堡县;缅因州;和西密歇根。这些地区在提高本地区向患者提供的总体护理质量方面都取得了巨大进展。现在,他们正在应对额外的挑战,即改善护理,减少系统中超级利用率者的不必要成本和支出。
这笔赠款是基于医学博士杰弗里·布伦纳的成功工作,他是卡姆登医疗保健提供者联盟(CCHP)的创始人和执行董事,该联盟致力于改善新泽西州卡姆登超级使用者的医疗保健服务质量和成本,RWJF此前授予布伦纳和该联盟90万美元,用于为每个项目提供技术援助。
他说:“像全国每个社区一样,这六个社区都有医疗保健热点,在那里,最复杂的病人过度使用急诊室,在很大程度上推高了护理的总体成本,因为他们没有得到所需的医疗和社会协调护理。苏珊·曼德, BSN, MPH, RWJF高级项目官员。“AF4Q联盟是开发和实施有效模式以满足急诊室外超级使用者需求的合适团体。每个社区的患者和需求都是不同的,所以这个项目将帮助我们了解在各种环境下最有效的方法,这样我们就可以为其他人提供复制的模式。”
今天的赠款是RWJF自2005年开始对CCHP投资的自然延伸。这六个联盟将努力审查医院记录,以确定他们所在地区的超级利用者。通常,这些患者患有多种慢性疾病和社会复杂性。
试点方案的目标是保持病人的健康,提高他们接受的护理质量,包括协调社会和医疗干预措施。该计划还将通过确定住院的替代方案来减少不必要的费用,这将减少医院的再入院率和不必要的急诊科就诊。
具体来说,这六个联盟将直接与CCHP和Brenner合作,通过直接为患者服务的护理团队,将患者转介到超级实用诊所,并与初级保健实践合作,建立一个所需的医疗和社会服务网络。这些联盟将为当地医生提供指导和支持,以便为高使用率患者提供有针对性的护理和病例管理。
布伦纳说:“这笔拨款创造了一个很好的机会,不仅可以帮助这些社区中最需要帮助、最昂贵的病人,还可以学习如何将这项工作扩大规模。”“这是一个全国性的挑战,但它只能一次解决一个社区。”
赠款接受者
马萨诸塞州卫生质量合作伙伴(大波士顿)
大波士顿超级公用事业试点项目
该项目将利用一个以社区为基础的试点团队项目(健康生活),该项目通过积极参与、护理协调和健康活动的结合,在提高高质量结果和降低超级利用率者成本方面取得了初步成功。该模式将扩大,增加一名兼职病例经理,专注于帮助患者与社区社会服务、消费者和信仰组织建立联系。
急诊科护理协调途径计划试点
该项目将利用现有的急诊科护理协调计划,建立一个试点社区外展小组。该小组将包括一名社区卫生工作者(领导)和美国志愿队志愿者,通过医疗、社会服务和行为健康服务网络协调服务和支持患者。一个由社会工作者、医院病例管理人员、医生和行为健康人员组成的多学科临床咨询小组将监督患者的护理。
为最需要的病人提供红地毯护理:大克利夫兰超级利用者项目
该项目将在克利夫兰的两家国家质量保证委员会三级认证的以病人为中心的医疗院里开发超级实用的“诊所中诊所”。这些诊所将配备跨学科护理小组,并将与10家地区医院合作,以确定和监测社区中的过度使用者。这些诊所还将与一个著名的宗教组织合作,将患者与非医疗支持联系起来。
调整部队洪堡
急诊科超级利用者的护理协调
该项目将通过两个现有的成功项目(护理过渡项目和重点护理)之间的合作,建立一个以社区为基础的团队,这两个项目提供病例管理和护士主导的护理协调。该建议最独特的方面是项目将在农村环境中运作,这将为在类似环境中开发超级利用率模型提供重要见解。
缅因州质量统计
缅因州以病人为中心的医疗家庭试点-发展先锋
该项目将使缅因州的全州社区护理团队(CCT)超级利用者项目能够选择和发展其当前的CCT之一,作为“先锋”团队,为该项目的未来提供信息。现有的有条件现金转移治疗项目由8个以社区为基础的、多学科的超级利用小组组成,这些小组与PCMH试点实践合作,确定将从额外的多学科护理管理支持中受益的高需求患者。
卫生联盟(西密歇根州)
急诊科高频使用者的系统识别与护理
该项目将利用肯特县现有的一个超级多功能护理诊所,将诊所的覆盖范围扩大到多医院模式。他们将通过当地医疗保险交易所,在肯特县所有急诊室和诊所之间建立符合hipaa的互动。
关于罗伯特伍德约翰逊基金会
罗伯特·伍德·约翰逊基金会专注于我们国家面临的紧迫健康和医疗保健问题。作为美国最大的专门致力于健康和医疗保健的慈善机构,该基金会与各种组织和个人合作,确定解决方案,实现全面、可衡量和及时的变革。40年来,该基金会为影响其服务对象的健康和保健的问题带来了经验、承诺和严格、平衡的方法。当涉及到帮助美国人过上更健康的生活并获得他们所需的护理时,基金会希望在您的一生中发挥作用。欲了解更多信息,请访问www.ottomotal.com。在Twitter上关注基金会www.ottomotal.com/twitter或Facebookwww.ottomotal.com/facebook。
关于为质量调整力量
为质量调整力量(AF4Q)是罗伯特·伍德·约翰逊基金会的标志性努力,旨在提高目标社区医疗保健的整体质量,减少种族和民族差异,并为国家改革提供真正的模式。该基金会致力于改善16个AF4Q社区的医疗保健,这是美国慈善机构迄今为止所做的最大努力。AF4Q要求获得护理、提供护理和支付护理费用的人共同努力,提高当地提供的护理的质量和价值。乔治华盛顿大学公共卫生与卫生服务学院卫生政策系的卫生保健质量中心是国家项目办公室。了解更多关于AF4Q的信息www.forces4quality.org。