United Hospital Fund Launches Quality Improvement Initiative to Improve Patient Transitions
25 Health Care Providers Are Working with Family Caregivers and with Each Other to Improve Patient Safety and Care
To address one of health care’s most persistent challenges, the United Hospital Fund has launched a new initiative, Transitions in Care–Quality Improvement Collaborative, or TC–QuIC. Focused on transitions of seriously, chronically ill patients between health care settings (e.g., from hospital to rehab or to home), TC–QuIC aims to achieve better coordination and communication between health care organizations and better integration of family caregivers in planning and implementing care plans. By building effective partnerships that recognize and support family caregivers and give them better tools for critical tasks such as medication management, TC-QuIC expects to help providers avoid problems that undermine patient care and too often lead to preventable hospital readmission.
Among the 25 participating health care providers from the New York metropolitan area are eleven hospitals, seven nursing homes, five certified home health agencies, one hospital-based acute rehab unit, and one hospice. Working together in teams, these providers will identify specific challenges to address, develop and implement plans to tackle those challenges, and evaluate their effectiveness.
“Change in general is not easy, and changing health care practice is tougher still, but that’s what we and the health care providers participating in this collaborative are committed to doing,” says Carol Levine, director of the Fund’s Families and Health Care Project, who is co-chair of TC-QuIC and is nationally recognized as a pioneering leader in the movement for family caregivers. Her co-chairs are David Cohen, MD, senior vice president for clinical integration and affiliations at Maimonides Medical Center, and Audrey Weiner, DSW, president and CEO of Jewish Home Lifecare.
While most teams involve two organizations that routinely work together, some are more complex. For example, one team involves Lutheran Medical Center and Maimonides Medical Center, Lutheran-Augustana Skilled Nursing Facility, and two home care agencies, the Visiting Nurse Service of New York and First to Care. And some organizations are participating on more than one team; the Visiting Nurse Service of New York, for example, is a participant on four different teams. All the teams will work closely together over the course of the 15-month collaborative, which is scheduled for completion in June 2011. In this time they will test new protocols and tools that aim toward improved assessment, planning, and communication.
Several partnerships plan to focus on patients with congestive heart failure because these patients take multiple medications and require close follow-up to avoid hospital readmission. By improving communications with, and the education of, family caregivers—through standardizing language and tools—and by coordinating transitions between settings, the hope is that avoidable readmissions and medication management problems can be reduced as much as possible, and the patient and family caregiver experience can be dramatically improved.
“While much of the work will be done in the provider partnerships, we will provide guidance and technical assistance, including individual or group coaching and site visits,” says Deborah Halper, vice president for education and program initiatives at the Fund. “We will also help participants find effective ways to work with the materials available on our Next Step in Care website [www.nextstepincare.org], which we developed to address many of the concerns associated with patient transitions.”
An estimated 34 million Americans, or one in five adults, are family caregivers—defined as relatives, partners, friends, or neighbors who provide or manage full- or part-time care to a chronically ill or disabled person. Family caregivers are an essential part of the health care workforce, providing 80 percent of chronic and long-term care in the U.S., and pressures on them are growing. Shorter hospital stays have increased the effectiveness of medical care, but also have shifted responsibility from paid to unpaid providers of care, increasing burdens on family caregivers.
“Across the country, the message from health care systems is the same: Coordinating care during transitions is challenging, and reducing avoidable hospital readmissions is a critically important, but not an easily achieved, goal,” says Jim Tallon, president of the Fund. “In addition to improving practices locally, this initiative will undoubtedly make a significant contribution to the national dialogue.”
“For too long, family caregivers have been invisible care providers in the health care system,” says Ms. Levine. “This collaborative is bringing them center stage. We need to make sure these family caregivers are prepared and able to take on these roles. The TC-QuIC participants not only recognize this challenge, but also are assuming leadership roles by working to address it.”
Beth Israel Medical Center
Coney Island Hospital
Lutheran Medical Center
Maimonides Medical Center
Metropolitan Hospital Center
Montefiore Medical Center
New York Community Hospital
New York Hospital Medical Center Queens
NYU Langone Medical Center
The Allen Hospital of NewYork-Presbyterian
Nursing Homes/Rehabilitation Centers
Cobble Hill Health Center
Isabella Geriatric Center
Jewish Home Lifecare-Bronx Division
Jewish Home Lifecare-Manhattan Division
Lutheran-Augustana Skilled Nursing Facility
Orzac Center for Extended Care
Saints Joachim and Anne Nursing and Rehabilitation Center
Home Care/Hospice Agencies
Extended Home Care
First to Care
HHC Health and Home Care
North Shore-LIJ Home Care Network
North Shore-LIJ Hospice Network
Visiting Nurse Service of New York
Funds to support the development of the Next Step in Care campaign, including TC-QuIC, were provided by Altman Foundation, The Jacob and Valeria Langeloth Foundation, Eisenberg Family Trust, TD Bank, Aetna Foundation, and The New York Community Trust, as well as the United Hospital Fund.
About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.