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Qualis Awards Spotlight Great St. Luke's Work

By Dr. David C. Pate, News and Community
April 30, 2013

Two clinical improvement initiatives from St. Luke’s were recognized by Qualis Health, the well-known care management organization that oversees quality for the Medicare program in our region, at the state-wide Quality and Patient Safety Conference held in Boise on April 5. 

These two projects were selected from numerous submissions and were among four chosen for Qualis Health's Awards of Excellence in Healthcare Quality. They represent significant achievements in meeting the Triple Aim of better health, better care, and lower costs.

These two examples highlight just some of the excellent improvement work in clinical care that is occurring at all of our sites and being shared among them. The changes are visible. And these relationships will expand as we develop our accountable care skills and abilities.

St. Luke’s is improving care because it is the right thing to do. We strive to be patient-focused and to put into practice St. Luke’s core values: integrity, compassion, accountability, respect, and excellence. 

It is an exciting time, and together, with staff, physicians, and community partners, we are making a difference in our journey to transform health care, one patient at a time.

Here are the winning St. Luke’s initiatives:

St. Luke’s Wood River’s Diabetes Care Improvement Project

Rural, critical access hospitals face challenges in providing the scope of services, expertise, state-of-the-art technology, and integrated care available in bigger communities, where hospitals see more patients and often have additional resources. This can make complex, evidence-based care of an ever-growing diabetic population difficult. 

When St. Luke’s Wood River identified diabetes as a primary focus for population health in 2010, they conducted an audit of clinic patients, comparing themselves with national benchmarks to identify gaps.

Nancy Dettori, RD, CDE, teaches a patient how to read nutrition labels to help manage her diabetes.

They found opportunities when it came to heightened awareness of the American Diabetic Association (ADA) standards of care, expanded scope of service to address their pediatric and pre-diabetic populations, and state-of-the art technology for improved patient safety and to improve the control of diabetes.

With the help of an Idaho Medicare Rural Hospital Flexibility Program grant in 2012, St. Luke’s Wood River formed a partnership with St. Luke’s Family Medicine clinic and St. Luke’s Center for Community Health (SLCCH) and collaborated with other sites across the System to put an expanded education program in place.

They made sure that certified diabetes educators and diabetes self-management training (DSMT) were available through the clinic, appointed a physician champion of the project, conducted additional training, and improved their use of technology.

Among the results:

  • Improved practice of testing hemoglobin A1C levels to at least twice annually from 63 percent to 81 percent of patients.
  • Increased the number of referrals to DSMT.
  • Improved diabetes care competency scores for clinic nursing and SLCCH support staff.
  • Improved insulin delivery options and effectiveness due to Medtronic Diabetes insulin pump training, and improved management of complex glucose patterns.
  • Decreased patient travel time due to purchase of two continuous glucose monitoring systems used for diagnostic purposes. Patients previously had to drive to Twin Falls or Boise for the tests.
  • Selection and implementation of a pediatric self-management curriculum.
  • Enhanced expertise in adult weight management.
  • Improved average hemoglobin A1Cs from 9.3 down to 7.4 among diabetics with self-management.
Wood River’s Clinical Leadership Task Force now is integrating components of the project in the hospital setting. A new audit process is helping clinic nurses identify patients needing call-backs for labs and exams. And Wood River has launched an eligibility fast-tracking pilot project for patients with financial challenges who need support services.

Other changes brought about through Wood River’s efforts have included work throughout St. Luke’s Health System on software programming to promote easier analysis of continuous glucose monitoring system data, development of resource material to address body image issues associated with type 1 diabetes among adolescents, and collaboration with the new St. Luke’s Diabetes Education and Management (DEaM) team for ongoing standardization and improvements.

St. Luke’s Treasure Valley’s Transitions of Care: Something to ToC About

Hospital admissions are a time of significant change, and the potential for introducing error or confusion to the care of a patient during or after hospitalization is high. The St. Luke’s Transition of Care (ToC) Team is a multi-disciplinary group focused on improving the care of patients as they move from the community to the hospital and back.  

Recently there has been much attention on readmission rates. St. Luke’s readmission rates are below national average, but the ToC team decided to look into the drivers of readmissions for opportunities to improve transitions of care.   

Various elements were examined, including readmissions by condition, time frame for readmission, patients’ discharge disposition at the time of readmission, communication with community providers, and opportunities with medication reconciliation. More than 250 readmitted patients were also interviewed to understand their perspectives on what could be done better. 

Based on their review of data and the interviews, the team determined that improvements in the areas of medication reconciliation, standardization of the discharge process/transfer of information, collaboration with community providers, improved processes for providing patient education, and improved communication with primary care providers were keys to improving the patient’s transition.

St. Luke's pharmacists have been instrumental to the ToC team's work, helping to improve processes for filling medication prescriptions when patients are discharged.

After pinpointing the opportunities, the team worked on solutions. A standardized process for medication reconciliation at discharge was developed and initiated. This step alone has resulted in error reduction in medication reconciliation from 18 percent to 10 percent in the pilot unit.    

The ToC team helped promote a tool, piloted by one of the nursing units, to standardize education regarding patients’ new medications. Use of the tool resulted in a significant improvement in HCAHPS scores, with patients scoring the pilot unit in the top 1 percent nationally. The teaching guide is now being used in other units and hospitals across the System.

A care transition program with the heart failure clinic, bridging the gap between hospital and home for  patients admitted for heart failure and myocardial infarction, has also been developed. Home visits within 72 hours of discharge to assess patients’ health status, align goals, evaluate patients’ educational needs, and provide medication reconciliation have reduced readmission rates in the intervention group to 17 percent compared with 21 percent for a control group, which amounts to a 19 percent relative improvement.

Other steps include a new inter-facility, nurse-to-nurse hand-off in collaboration with the Elks Rehabilitation Hospital. This process provides a standardized framework for communication with

Transitions of Care team members schedule follow-up appointments.

Community partners about a patient’s condition prior to transfer, ensuring better care. A campaign to improve communication of discharge summaries from inpatient physicians to primary care doctors is also under way. The hospitalists have already improved the percentage of summaries signed within 72 hours from 70 percent to 80 percent.

And a standardized process for scheduling follow-up appointments prior to a patient’s discharge, now being piloted in partnership with St. Luke’s Connect and St. Luke’s Internal Medicine clinic, ensures early access to follow-up care and timely intervention if a patient’s condition is unstable, improving the health of the patient and reducing cost by avoiding preventable readmissions.

Congratulations to the many passionate people within St. Luke's who work so well and so collaboratively to deliver better care at lower cost. That's what I believe Qualis has seen and is recognizing in these initiatives. And there's more where that came from! Thanks to all!

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.