Better Outcomes Through Patient Education
Patients have an equally important role to play in reducing cost and improving value as do the doctors that coordinate their care during an episode. This is especially true for the post-acute care after discharge and the 30-90 days following returning home as included in the episode of care. During this time, it is up to the patient to manage their care for best outcomes.
Unfortunately, very often after discharge care providers lose touch with the patient, or cannot be sure the patient is following their instructions at home. Patients themselves are also not always sure they understood their providers, or receive seemingly counterintuitive information on how to do their part in looking after their own health. This can lead to serious complications, which in turn drives up costs for providers. Many providers are already feeling the pinch on their profits, with health analytics company DataGen, a partner of the AAMC, reporting the most common reasons for readmissions being sepsis and the need for revision surgery- two complications that prove to be costly. Sepsis readmissions alone cost the state of California an estimated $500 million annually, a cost that arguably could be reduced through patient education. Education on wound management after discharge, cleaning the wound, recognizing the signs of infection, and understanding the importance of taking their antibiotics as prescribed could have contributed to lowering the risk of this complication.
The problem lies in a lack of education and accountability of patients in the role they have to play in their own care. Patients are no longer just customers but partners as well. They need to understand how their compliance affects their health outcomes, just as providers are beginning to understand how their patients’ compliance affect their bottom line.
Traditionally, patients have received their care education through a quick chat with a member of their care team or received pamphlets from their provider to review at their leisure. Some hospitals, like Overlake Medical Center, have even taken the initiative to organize informative classes patients can elect to take to better understand their diagnosis and their treatment path ahead.
However, these methods have clearly not been engaging enough, as post-discharge surgical complications continue to cost payers $250 million in additional costs given a 30 day discharge period. With bundled payments here to stay, it’s hard not to be concerned about how the cost of readmissions for complications will affect your hospitals gainsharing efforts under the bundled payment terms. Under the BPCI and CJR programs, if your spending for an episode exceeds the the projected cost for that episode’s DRG, the provider is required to pay the deficit, in a strategy known as loss-sharing. This is meant to disincentivize loss-sharing caused by unnecessary overspending and instead promote gainsharing by staying on budget and avoiding costly complications through efficient care in order to keep the difference as profit. Engagement and education clearly has a significant role to play to help providers avoid overspending through avoidable post-surgical complications.
Some success has been seen with the use of hospital sponsored group-appointment programs, like Joint Club, to fill the gap on on-going education and experience sharing. In programs like these, patients can meet with others who are navigating through the same episode and compare their milestones and experiences along their journey while receiving education and guidance from an attending care support member. Also applicable to diabetes management, studies suggest that the with this method outcomes are tied with attendance compliance – the greater the attendance the greater the benefits to all those who attend.
Others have found that a personalized education plan that included multiple follow-ups on the education received was effective in keeping patients on track after discharge. A study conducted by Ryerson University found that an individualized education plan reduced complications and readmissions 12 weeks after surgery compared to a one-size-fits-all booklet that is all too common in most hospitals.
Still more have implemented Care Paths, an evidence based guide that details all the steps necessary to ensure positive outcomes for patients with minimal interruption to existing workflow, including education. By using algorithms and integrating with EMRs, Care Paths can identify at risk patients, intervene with re-education or re-training when necessary, and keep track of upcoming milestones for ensured outcomes. The Cleveland Clinic has seen promising results in their Spine Care Path, with significant reductions in pain prescriptions and cost, and an increase of patient education to 93%.
Care Paths seem to include the best of all worlds for patients and providers alike- engagement in education are on-going and driven by evidence of best practices. The more evidence is gathered by participation in Care Paths, the more the paths can be refined to optimize engagement and outcomes. Already extensively used throughout Europe, Care Pathways have much to contribute to engaging patients in their care and involving them in their own outcomes in the bundle payment future.