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Patient Experience Case Study - Mercy Health System of Maine
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Mercy Health System of MaineOSF St Francis

 




Reducing Readmissions through a Patient Self-Assessment Tool
Identifying Key Non-Clinical Issues Early After Admission

What was the challenge, opportunity or issue faced?

Mercy Health System of Maine, like many providers, has been working to find ways to continuously improve readmissions rates and target efforts towards discharged patients at high-risk for "bouncing back” to the system’s hospital, Mercy Hospital, located in Portland, Maine.

"The Medicare penalties for high readmission rates in acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia, provided the financial impetuous to seek funding and resources to support these efforts have been a priority for us,” said Scott Rusk, M.D., Chief Medical Officer of Mercy Hospital.

Mercy Hospital, like many safety net community hospitals, serves a large number of Medicaid and uninsured patients who have limited resources once they leave the hospital, and makes efforts to ensure their patients follow discharge instructions. As a result, many of the hospital’s patients are at risk of a medical setback – resulting in a readmission or Emergency Department visit – which are for the most part for non-clinical factors, including financial, socioeconomic, emotional, literacy, transportation and other social support issues.

What did you do to address it?

In an effort to address these non-clinical factors contributing to readmissions, the cardiology department at Mercy Hospital piloted a patient self-assessment tool, the Patient Performance Enhancement Tool (the "PET”). Developed by the Patient Performance Institute, the PET asks for patient feedback in a number of non-clinical areas which evidence-based studies show impact health outcomes: financial, social, logistical, emotional, health literacy and preferred learning styles. It also asks the patient to provide historical information about following doctors’ recommendations during past illnesses and to indicate if the provider teams have been confusing in their conversations to-date.

"We thought it would be useful to trial a process where we captured this information from the patients before the discharge planning process had begun,” said Dr. Rusk. "We were hopeful it could assist us further identify high risk patients and the way to help them be successful as possible once they left the hospital.”

During the pilot, the participating Mercy cardiology patients would take the PET soon after their admission and typically without the aid of any Mercy staff member, to increase the patients’ candor. Once the survey was done, the Patient Performance Institute team would process the answers and within a few hours, send the Mercy team a summary one-page report highlighting the risk factors and special alerts. Sample alerts would be:

  • Patient is worried about paying for prescription drugs
  • Patient is confused about medical instructions
  • Patient has not followed doctor’s orders in the past because he didn’t believe the doctor was right

The PET report would be added to the patient’s electronic medical record, for wider dissemination. Because the entire process was usually completed the same day that the patient filled out the survey, the Mercy nursing and case management team could use the results to manage the patient through the rest of their hospital stay, and in particular the discharge process.

Additional benefits came because the Visiting Nurse Service Home Health & Hospice ("VNA”) affiliated with Mercy Health System of Maine had some of its nurses trained on the use of the PET report. When the Mercy Hospital cardiology patients were discharged, these VNA nurses utilized the PET results to manage the patients in the home setting.

What were the outcomes?

The pilot bore fruit. For the 49 cardiology patients which participated in the pilot, the readmission rates were approximately two percent lower than the other 55 AMI and CHF patients treated at the same time who were not approached to participate. Given that Mercy Hospital has seen its readmission rates consistently drop through a number of other initiatives it has been utilizing (including a patient educator who works with all of its CHF patients upon discharge to manage their self-care), this result was notable.

Even more interesting were some of the qualitative trends. For example, 100% of the patients who were readmitted had issues with respect of authority or trust in their doctors.

"That was the most surprising result,” noted Dr. Rusk. "The PET allows you to track the trends on why patients may be failing once they get home – and by giving actionable, predictive data, you can do something about it while the patient is still in your care. For doctors, this tells us we have to be sensitive to ways to increase trust in our communications with patients. Coupled with our Mission Department and a MeHFA grant, Mercy has placed a Patient Navigator in our ED and partnered with Amistad to provide community based peer counselors to bring the medical home out of the office and into the community to help build trusting relationships.”

About Mercy Health System of Maine
Mercy Health System of Maine includes Mercy Hospital, Gary’s House, McAuley Residence, Mercy Recovery Center, and VNA Home Health & Hospice. The Mercy Health Care System provides a broad range of medical and surgical services, as well as primary and specialty care to provide a continuum of care for our patients in southern Maine.

A not-for-profit organization, Mercy is sponsored by the Sisters of Mercy of the Americas, Regional Community of Portland. Mercy is a member of Catholic Health East, a multi-institutional Catholic health system serving communities through regional healthcare systems in 11 eastern states from Maine to Florida.

For more information on Mercy, please call (207) 879-3486.

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