Resources for Reducing Readmissions in Inpatient Psychiatric Facilities

Resources for Reducing Readmissions in Inpatient Psychiatric Facilities


Welcome to today’s webinar Resources for
Reducing Readmissions in Inpatient Psychiatric Facilities I’m Candy Hanson
a program manager from Stratis Health in Minnesota with me today i have Jon
Glover, project specialist with MetaStar in Wisconsin and Barbra Link, senior
quality specialist with MPRO in Michigan. We’re so happy you joined with
us today. Our objectives for today’s webinar are to: learn the basic skills or
to learn about the basic skills, to prevent and deescalate mental health
crises, understand how the readmit tool can help determine the risk for
readmission following an inpatient psychiatric stay and we’re going to
explore some strategies on how to improve the discharge process to reduce
readmissions. You probably already know this that our three states currently
make up the Lake Superior Quality Innovation Network . We will soon be known as the Superior Health Quality Alliance in the near future and we’ll be adding
hospital partners and other stakeholders to our teams. I’m going to start by
sharing with you a mental health video training series that Stratis Health did
in collaboration with one of its coordination of care communities in in
late 2018. It was originally designed for working with mental health clients in
nursing homes but has much broader relevance to a wider audience and has
some really great information in it. It’s for those care providers and caregivers
especially those without formal clinical training programs although I’m a nurse
by background and having viewed it several times, I think it’s a great
refresher on just some basics about working with people with mental illness
especially older adults, as well as some techniques that might be kind of obvious to us but I think it’s always good to have a place
for reminders. I also see relevance for family caregivers, especially in the
first video which I’ll talk about in just a minute because it does a really
nice overview of the categories of mental illness.
It also has relevance for direct care staff. I can see it being used for annual
training or orientation for people working with behavioral health clients
with behavioral health needs. I just see a whole variety of uses for this video
series. Each of the videos is less than 30 minutes in length
and as we go through them I’ll remind you how long each one is and as I said
before even as a nurse who’s been in practice for over 30 years,
I just thought these were really good refreshers and you know I think that
we can never assume as I mentioned some of the de-escalation techniques when I’m
smiling as I say this because when I was watching it it was like are you kidding
me, you’d never talk to someone like that, but I don’t think we can ever make that
assumption that people just don’t, not even out of you know malice, but just get
really frustrated sometimes and so it’s just really some good reminders in there.
The training goals of the video service were to boost understanding of
older adult mental health, to equip providers and caregivers with techniques
to prevent and deescalate behavioral crises that may lead to unnecessarily
hospitalization, as well as could be potential safety issues for both clients
and caregivers, which ultimately will improve behavioral and mental health
outcomes for older adults and again I think anything we can do to
address the stigma around mental health and encourage more education and
training is always a helpful thing. The first video is called Older Adult Mental
Health Basics and it’s 23 minutes long. As I said it
explains common mental illness disorder categories it shares some compelling
statistics, addresses the fear and inadequacy many providers and caregivers
feel it, confronts stigma and derogatory labels and I think it expresses hope and
talks about treatment and how it can be effective. It conveys how you are at a
care provider or family caregiver can support and it provides resources for
more help. I think this first video would be
helpful for an older adult who has been diagnosed with a mental illness for the
first time or for someone who has been struggling with one for some time. I
think it does a very nice job of normalizing mental illness as a chronic
condition. It talks through issues such as depression, anxiety, substance use
disorder, bipolar personality disorders and schizophrenia and post-traumatic
stress disorder. The second video Preventing and De-escalating Mental
Health Crises is 27 minutes long. It describes common behaviors and triggers
likely to cause behavioral events, it suggests prevention tips to reduce
behaviors and it describes the cycle of crisis escalation.
It also has a couple of vignettes where it does role-playing and demonstrates
the right way and the wrong way for de-escalation scenarios and how to apply
new learning after an event and in addition to that it offers some
additional resources. In a couple of minutes, I’m going to play a short
excerpt from this video to give you an example. The third video Person-centered
Care and Collaboration is 17 minutes long and it describes the importance of
individual behavioral care plans and creative solutions to diminish or
redirect behaviors, when to consult with outside as well as when to consult with
outside professionals it also describes for you the steps for actually
implementing a person centered care plan for someone with behavioral
health issues. Each of the videos has a 10 question quiz that is available and
it also then has a so you could do this in two methods you could either fill in
the quiz answers sort of as an open book test as you’re going through the video
or you could just provide a quiz after viewing and then after checking or ask
for answer checking there’s another resource then that gives you the answers
for each of the questions. For each of the videos there’s a fact sheet on the
three topic areas you could use the fact sheet as a separate handout or it’s
something that I think would be would go well to post in a break room for staff
as well and then third there’s there are some pocket-sized
action checklists so if someone could carry these and apply them during their
work or they could be posted on a med cart or something just reminding
you about some things about dealing with people with behavioral health issues and
then there are sample plans and templates for each video.
The geriatric depression screening tool is available after the first video.
There’s also a sample crisis plan for the second video that I really love
because it gives if it’s an interactive plan that can be done with the patient
or client and it’s really an opportunity for them to think about and to talk over
with you, you know a prevention plan where there are things like what are
their triggers that they can think about, what might be some of the physical
symptoms we could expect to see if they were feeling that they their
illness was triggered by something when they’re going into crisis and also
things that make them feel good and things are way
that have been used in the past to help calm them down. It helps you do this in a
proactive manner so that the caregiving staff is aware of these things and can
use them to build upon the clients strengths, as well as to use what the
client has identified that already works and so I really like that
particular tool and then what’s shown here is a person-centered care plan
template and it’s got things I think that are very person-centered about
things that the client that are important to the client and again I
think the combination of all of these tools really helps you to know your
behavioral health clients at a different level and be able to interact them in a
way that that you might not that some staff might not have thought of doing in
the past. So I’m going to take a couple of minutes in just a second here to play
just a two-minute excerpt from the second video and I hope it will work on
the browser that you are signed in on but if not you should still be able to
hear it on your phone and as I said it’s only like two minutes long so if you
can’t I asked you to stay with us even if you have some technical issues seeing
it. Alright here we go. Here’s another common situation you come upon a person
who is physically agitated and verbally abusive, you need to de-escalate behavior
that might lead a person to hurting himself or others. In this clip, the
caregiver sees John physically agitated. He’s pushing his food away and yelling
at everyone to leave him alone. The caregiver is worried John might hurt
himself or others. stop it right now.
I can’t stand this place.
calm down. You calm down
listen I mean Tashi are not …
You get your damn hands off me
You’re the meanest person I ever met, I get a
headache just looking at you.
You’re the most stubborn person I ever met.
Hit me, go ahead hit me, I dare you! How did things spiral out of control so fast? What actions did the caregiver do that you should never do? If someone were to do a clothing grab and grab my my shirt I’m gonna do a windmill and spin my arm away
and use leverage and momentum to get away from something like that. If
someone’s going to try to take a swing at me, I’m going to try and block it and
use leverage and momentum and I’m going to go away. Let’s take another look at
the same situation again. I’m sick and tired of place. Leave me alone.
It sounds like you would like to be by yourself for a little while.
It’s so noisy I have a headache. I’m hearing that your head hurts, how long has this been going on? Since last night! I hate this food and I hate
you too!
I think we should work to see Tammy you know Tammy she’s our head nurse, the one who helped you when you had pneumonia.
My head really hurts.
That’s why we should see Tammy, you might be able to
leave you some medicine. That would be great, I can’t concentrate.
I understand it must be really tough how you feel right now.
I’m really glad you’re here tonight, thanks for listening. okay alright so I hope that was just helpful for you to see as I said you know when I look at
the first scenario I’m like oh I don’t think anybody should ever be talking to
anyone like that and hopefully that’s not the case but as we know sometimes
people just get really frustrated and and don’t act in the way that they’ve
been trained. So so all of the resources I’ve described today can be found at the
link in the slide and the slides were sent out to you on Monday
and so if you click on that link it’ll take you to the Lake Superior Quality
Innovation Network website and all of the resources that I mentioned earlier
are all on that one page. So you’ll have the first what are the first video and
then the accompanying resources, the second video and so on so I hope you
find value in this free video series in your ongoing work. I didn’t mention it
when we got started but we’re gonna just ask you to hold questions until the end
so that we can make sure that we all get through all of the topic areas. So now
I’m going to turn the presentation over to Jon Glover from MetaStar in
Wisconsin. Jon and you just tell me next slide Jon. Great can you hear me okay
Candy? Yep, I can hear you just fine Jon all right thanks a lot that was really
great those are great videos I hope people are able to access them and and
make use of them with their employees. I’m here today just to talk to you
briefly about the READMIT risk stratification tool. you can go to the
next slide. on the readmit risk stratification tool
is comes from the model developed by clinical researchers at the University
of Toronto in 2014. it’s the only tool we’re aware of that was specifically
developed for the behavioral health population and we know that there are
other tools that general hospitals use like the lace
but these often don’t have a behavioral health component to them and this
particular tool used a really large population of data that included about
32,000 records and they did a retrospective use of this data to create
the various categories that are used. next slide next slide please. just having a little bit of trouble here What we’re going to do is we’re going
to talk just a little bit about where this stratification is. There we go.
Risk stratification is a process of assigning risk status to a patient in
order to better direct their care, apply appropriate interventions for them and
improve their overall health outcomes so this is the goal and now we’re going to
take a look at the READMIT model itself so you can get an idea of how it works.
next slide, There is so here’s the basic categories of the READMIT model.
The first one is repeat admissions and this has to do it how many admissions
has the patient had in the you know in their lifetime.
Next is emergent admissions and this is when the person is a threat to
themselves a threat to others or they’re unable to care for themselves.
Then we have age and this category has broken down into about nine different
groups the lowest score for age is in the 94 and up
category and that’s a zero the highest score you get for ages in the lowest or
the youngest population which is the 18 to 24 year old. Then next you have
diagnosis and discharge status. Here you’ll get particular points for the
diagnosis that the patient has when they’re coming into the hospital,
this can include personality disorders and also any unplanned discharges that
the patient may have had in the past. So that will give the patient I think it’s
five points for an unplanned discharge. The next area is the M and that has
to do with medical morbidity. This particular session section uses the
Charleston comorbidity score over the past two years and we’re going to talk a
little bit more about that for those of you who may not be familiar with it just
to give you a sense of what that looks like. We we’ve been able to develop a
pretty quick way of getting that score and then the I stands for intensity and
this is the amount of outpatient and emergency room contact the patient has
had in the last year and then finally the T stands for the time in the
hospital and since we’re doing this on admission, we’re looking at the amount of
inpatient days we’re expecting to have, the first category really goes up to 14
days so I’m assuming that most people are going to be hoping to get a patient
in and out within that time period. next next slide please. So our team
created a tool in Excel to automate this process using the data from their
original study that the clinicians in Toronto did. What we did was use their
distribution of scores to create low medium and high categories of risk. The
scores can range from zero to 14 and you can see here on this slide that the
highest category of risk indicates 26 and above and these people showed a
risk of 30-day readmission that was 20% or greater and when we look at
readmission rates, people in that particular category are definitely ones
more high-risk category. One of the things that I thought was really
interesting that a colleague of mine pointed out was that even though people
in the high-risk category very clearly would benefit from additional attention
and support while they’re in the hospital, actually even people in the
medium category would still benefit or warrant some some increased attention to
make sure that they were not readmitted thirty days. So the nice thing about form
is that once you’ve completed it you can record the results and then clear the
form to allow for the next patient to be scored. So let’s take a look at it. next
slide. So here’s a screenshot of what the form looks like. You can see that each
risk factor has a description of the variable that’s being evaluated, along
with a value that is associated with that variable, so that points can be
attributed to it and we’ll see what that looks like here in a minute, but I’ll
walk you through this particular slide. repeat admissions, if there’s one to two
you get two points, if there’s three to five, you get five points. There
emergent admissions, you get a point for any one of the categories of either
threat, threat to others or threat to self. You do get two points though if the
patient is unable to care for themselves and then the age category like I said is
developed divided into zero to eight scale based on how all the person is, the
older the patient is the lower that point value is, the younger the patient
is the higher the point value is and then the D for diagnosis, you’re looking
at their primary diagnosis. Give you a quick rundown there, depression
you’ll get two points psychosis or bipolar disorder will give them patient
four points, other psychiatric diagnoses give the patient three points, then under
personality disorder that’s two points if they have a diagnosis there and as I
said any unplanned discharges that may have occurred in the past that’s five
points. So next to this medical morbidity and this is where the Charleston
comorbidity score comes in and like I said we’re gonna look at that in just a
second but just to give you an idea, you can get one or two points, the lowest
score being one or two three or more on that particular scale gives you two
points. So it’s very quick and easy to do and we’ll see how easy that is to manage
here in just a minute. Then we have I for intensity and here we’re looking at
outpatient visits in the past year or emergency department visits in the last
year and so with the outpatient visits, if you have two or more than the patient
would get two points and if they’ve had any ER contact in the past year they get
three points and then finally time in the hospital, this is divided into
various links to stay as I said four to 14 days will get person four points, if
you keep them longer 15 to 28 days, it goes down to three points and then if
they be in the hospital twenty days twenty-eight days are longer they found
that that’s actually zero points. So again the range is zero to forty one. The
highest range, the one that you’re most concerned about is 26. All right
so let’s look at what this looks like as it’s being filled out. next slide. yeah so
this I want to put this up to give you an idea of what the drop-down choices
might look like and how the slide might look as you’re filling it out. You can
see there that the top is already filled in a little bit, you can see how those
values if it will automatically give you some points
added up there at the bottom. We’re currently on the D the diagnosis section
and this particular one is showing that the person has depression and just so
that it automatically you get it two points on showing up there
and so each of these choices are going to add up, you just pick from the drop
down menu, the points will add up for you and then we’ll see here in a minute what
happens is they get highlighted using a red yellow or green stoplight type of
approach to give you an indication of low medium or high risk for the
admission. So what I’d like to do like as I said is take a minute to go to the
medical morbidity in Charleston comorbidity score and show you just
quickly how we’ve helped to make that a pretty quick process. next slide
please. So I know you can’t read this slide it wasn’t intended for you to
read. It’s just intended to give you the idea that on the second tab of our Excel
document, we have instructions and I’ve got the big arrow pointing to a
hyperlink there that will take you you just click on it takes you right to a
web link that we’re going to see in a moment, that will again automated to run
you through the Charleston comorbidity scale and give you a score. So this tab
will run you through all the instructions but it’s also where you
find the link to the Charleston comorbidity index. Then when you get
that you can just go back to the patient form to put it in to the table. So let’s
go to the next slide and look at the Charleston. So if you look at the
Charleston, the first one is patient age so you get
a certain amount of points based on the age of the patient and then really
quickly it’s simple yes/no to any of these various comorbid conditions that
the patient might have so you can tell that
this is a pretty quick assessment to do. You just simply click on the ones that
the patient has and then there’s a calculate button and boom, they’ll tell
you what the score is and to remind you when you go back to the READMIT if the
score is one or two on the Charleston then you get at one point if it’s three
or more you get two points. So it’s again it’s pretty simple. They give you some a
simple example to go by, let’s say we have a 65 year old being diagnosed with
diabetes that’s being admitted, if you were to fill this out between the
patient’s age and having that one comorbid condition the patient can get a Charleston score of four and since that’s more than three, this patient
would end up with two points on the READMIT, so pretty simple process. so let
me, next slide. Let’s take a minute you go through a quick case example, I
think this might be the best way to give you this a quick idea of how easy this
is to use. So this patient being admitted to the hospital today is complaining of
depression and suicidal ideations with a plan.
He’s a 31 year old white male with bipolar disorder, he’s been hospitalized
on three previous occasions in his life and he left his initial hospitalization
AMA, feeling angry and believing that his diagnosis wasn’t correct.
He has since acknowledged the diagnosis and begun outpatient treatment, but he’s
been hospitalized on two additional times due to severe depression episodes.
In the last month, he presented to the emergency department with suicidal
ideations, but was sent home in the company of a friend with a safety plan
to followup with his therapist. He denies any significant medical issues. So not
too unusual patient for an IPF to see and make perhaps being in this, so let’s
take a quick look, next slide, at what his READMIT might look like.
So you can see very first he’s had three admissions prior today, so that gives him
five points, he admits to current suicidal ideation, that gives him a point,
he’s 31 years old, so that’s seven points and then he’s diagnosed with bipolar
disorder, which is four points. He did have one unplanned discharge when he was first diagnosed, so there’s five points attributed to
that, he did does not have any medical comorbidities so there’s zero points on
the Charleston comorbidity scores. He has had more than two outpatient visits in
the past year working with his therapist so there’s two points to that and then
he was in the emergency department the last month, so that’s three points. We are
hoping that we’ll be able to treat this young man in about 14 days or less, so
we’re going to put four points in there and you can see here a total score there
is 31 and there’s your red highlighted risk of readmission saying high. So one of
the things that I think’s interesting about this particular situation is that
this patient is probably not too unusual for our IPFs to see and sometimes we see
even more difficult patients than this, I think it would be understandable that we
get used to seeing people like this and may not necessarily think that this is
going to be someone at risk for a 30-day readmission. So the READMIT tool perhaps
can give us sort of some data to look at to remind us that, hey pay attention, this
guy actually has enough risk factors to warrant some additional attention and
guidance throughout his hospitalization to ensure that he has adequate support
when he’s discharged and reduced the chance of his readmission.
Right so that’s kind of an overview to READMIT. I hope it’s been helpful in
helping you to see how we can use this to identify potentially potential and
high-risk patients. Now Barbra Link is going to help us by showing some of the
tools and things that we’ve created to hopefully help you deal with. Jon, this is Candy, just before we get going with Barb, I think I wanted to make sure that you
mentioned the point about the one point increase in READMIT and how that that
percentage of readmissions goes up. Sure, Candy’s talking about, and this is
something that came out of the research on this tool, that it’s a zero to forty
one point scale, but the researchers found that even a one point increase in
the READMIT score, increase the odds of a 30-day readmission by eleven percent. So
that it’s really it’s really huge each point that they get on this tool I can
have a huge impact on their potential for readmission. Thanks Candy, I appreciate you bringing that up. yeah thanks Jon, that was great. Barb, you there? Let’s see, maybe I can unmute Barb. If
she’s having trouble with that I don’t know what happened to Barb. oh maybe I’m
noticing that our phone lines seem to way here we go maybe she’s there now
Barb are you there? huh She was on, okay okay let’s see what
happens here, oh she must have gotten disconnected. looks like I think that her
video is still up but she was joined by phone.
sure so oh she can hear. yeah she’s gonna try to re login, no barb you can I’m
trying I’m hitting your phone line Barb. yeah try to make her a host, maker
yeah make our co-hosts oh yeah let’s try this
hang on a second sorry about the technical difficulties here. alright so
um barb, I just made you a co-host and I can see your cameras on but I am
still not, is she responding here still sorry folks
hopefully we’ll get Barb up here in just a couple of seconds, otherwise we’ll… can
you hear me now? We’ve got you now Barb. okay I apologize everyone I had to hang up the phone line
and come in through the computer but I’m I sound alright through the computer? Yep
you’re just fine Barb, oh you’re doing great thanks. Alright sorry about that
everyone. Glad you can hear me now, so I did want
to thank Jon, even though there was a little bit of a delay, so I’m going to
talk now about tools and resources that the Lake Superior QIN regional staff
developed. We compiled some new resources and we targeted them specifically at IPFs
for their use when you working to reduce their readmission rates. so next slide. great, alright so um one of the areas
that we decided to focus on were some specific readmission toolkits and
practices that have been developed one of them have is the project
re-engineered discharge and that’s project RED as you can see this nice
one-page so it’s a pretty extensive toolkit researchers at the Boston
University Medical Center it developed and tested the reengineering
discharge through and through research they really found that it was an
effective way of reducing readmissions post Hospital emergency EP visits as
well and so what the staff at LSQIN decided to do
was to develop this one-pager toolkit that helps you navigate through the, the
RED toolkit is very extensive and it has quite a few documents that are included
in the toolkit, and so the staff felt that by compiling a checklist, it would
help to navigate the toolkit in an easier to use fashion. It really is able,
if you’d like to go the next slide so, on the thing that’s very nice about this is
that it really does lay out the steps for implementing RED standards but
through the checklist it provides an easy to navigate list of the full
toolkit from initial steps of gaining leadership buy in, on all the way to monitoring
the implementation and outcome measures that are part of the RED standards, so in
you can actually go to different sections and check out different
components of it and you don’t have to go through the whole very large tool kit
so you can target certain areas that you might be interested in and that would be
very beneficial and getting a little bit overwhelmed by the extensive toolkit
that’s project RED. alright next slide. The other thing that we felt that would be
important to do was to develop some additional resources for IPFs.
We certainly know that there’s a lot of resources out there regarding
readmissions and reducing readmissions for the medical component of hospitals,
but specific to behavioral health issues there wasn’t as much out there so we
thought that we would develop sort of targeted information for the IPFs to use
and so we developed this IPF resource flier. Many of you might have seen this
flyer in the past, but what we decided to do was to update it and streamline some
of the resources, so they would be current and easy for you to
at your facility. So included in this flyer is information on readmission
reduction models, articles, tools and handbooks that provide innovative
strategies specifically for IPFs in reducing readmissions and then different
toolkits that also assist patients and their caregivers in working with IPFs and
dealing with discharge issues. The other thing that I find that’s very helpful
about this is every one and we’ll talk a little bit more about this at the end of
the presentation is that all of the IPFs listening today should have received
these tools via email by now, the Project RED checklist as well as the inpatient
psychiatric facility resource and once you receive them via email
then all you have to do is click on the hyperlinks in the document and it takes
you right to where you want to go. It takes you to further information and it
takes you to websites and gives you more details about this specific article,
toolkit or resource that we’ve provided. alright next slide. So now I’ll just give
a brief overview kind of a high-level of some of the resources that you’ll find
in IPF resource document. I always have liked the Bridge Model it is a standard
readmission reduction model, but the thing that makes it somewhat unique to
other readmission models is it is very person-centered and that it’s social
work lead, so it really looks at an interdisciplinary model of care, it
involves community organizations in the discharge planning to reduce
readmissions and it even includes the Aging Network, so it’s it’s focused on
the older adult population. next slide please.
We also included the roadmap to behavioral health care and this is a
pamphlet that is patient-centered and a self-advocacy to all for behavioral
health patients. It helps patients to understand how their insurance coverage
and what are some of the best ways to use their insurance coverage to improve
their mental and physical health and it also provides eight steps that provide
important information on behavioral health issues as well as navigating the
behavioral health system, so it is very easy to use. It’s a brief pamphlet but
it’s something that’s very focused for your patients that can help them once
they’re discharged sort of navigate the health care system and stay in the community
longer. next slide So the RARE: Reducing Avoidable
Readmissions Effectively is another readmission reduction strategy that is
housed on the flyer and as you can see the website is here in the slide deck
but it’s also you can just have that flyer as a one-stop shop for yourself
and find all of these resources. This particular readmission reduction
intervention provides five key areas to focus on comprehensive discharge
planning, medication management, patient and family engagement, transition care
support and transition communication and all of these factors we know are very
important in the IPF setting, so we thought it would be good to include it
in our resource flyer. next slide and then yes RARE is another readmission
tool and it focuses specifically on addressing readmissions for mental
health and substance use disorder population and it is very targeted at
that population so it is incredibly helpful in the IPF setting. and the last
slide. So Jon went over the READMIT tool in quite a bit of detail, he showed you
the Excel spreadsheets, he showed you the comorbidity scale and all of those
documents even the the other components of it where it provides instructions and
such for populating the Excel spreadsheet are all housed at that
website, so you can easily find it it even has a link to the original article
that Jon was citing today in his presentation as well. So if you’re really
interested in trying to integrate this into your EHR or if you want to just
give it a try on a few patients, all those documents are found linked into
the flyer and you can get them all just by going to that one link and download them there if you’re interested. So again, I just wanted to
reiterate that if you’re an IPF that received the invitation to this webinar
today, then you should have received all of those documents the checklist as well
as the behavioral health flyer via email. if you have not, Candy, Jon and I, all of
our contact information is listed on the very last slide and you can always reach
out to us and we’ll easily send all that information to you today. Thanks very
much and I’m glad you all could hear me. yeah thanks barb. oh we have a few
minutes left, so I just wanted to open it up now at this point I have unmuted
everybody and, or at least I believe I have unmuted everybody and just wanted
to know if anybody out there has any questions or if anybody is wanting to
speak up here and share you know any other resources that they’ve found to be
extremely useful in reducing readmissions or just questions in
general about anything that we’ve presented today. We’ll give people just a couple minutes if
anybody does have any questions or comments or anything. Candy, this is Jon, I
just like to say we’ve had some some folks express interest in trying to
implement implement the READMIT and we’re more than happy to talk with you
more about putting together a pilot if you are interested in that
and we’ve had some interest out from the East Coast from a hospital out on the
East Coast so we’re trying to set some of the information that way as well and
they’ve actually indicated that you know like Barb said they would like to
integrate it into their EHR, so that it was more readily accessible for you.
Great idea I think it wouldn’t be terribly difficult to do that you know since it’s
already pretty much laid out. Yeah agreed no I think it’s to me, it looks like a
great tool and it would be good to have some folks pilot that or whatever
and just see if it you know if it was a really good predictive indicator of
readmissions, absolutely. Hi, this is Jackie from Detroit Wayne.
Hi Jackie, how are you? I had a question can you any of you talk about what the readmit rates
so what it was prior to using some of these tools and where you are now with
it? So Jackie, if I if I’m understanding
you’re wondering what it was prior to us creating the automated tool is that
right? Yeah yeah. It was a study done by
researchers out of Toronto University of Toronto and they had not automated the
information but they had an extensive study with lots of tables and charts and
32,000 sort of population that they worked with, so it was primarily just one
of the first studies trying to identify an a model for psychiatric patients in
psychiatric hospitals right because we didn’t have that prior, you know we had
the lace and some of the other general medical readmission risk tools
but there was nothing really for the behavioral health or psychiatric
population. So they did 2014 and we learned about it the course of our work
with the IPFs and one of my colleagues said you know we can automate that
information to make it even easier for people to use, because it wasn’t really a
tool like we just showed you, that’s easy to use, the study the study you know
or are multi pages and very in-depth and complicated and so we
took all that information and automated it into something that we hope is very
simple or some use and quick to use so that you can get an idea of what
patients might benefit from Project RED or RARE or whatever kind of
readmission risk reduction you’re trying to do. So so that’s kind of what we’ve
done with it and we’re really interested to work with folks who might interested
in doing a pilot, an idea maybe to do a pilot for a quarter at least and then
look at that in comparison to a previous quarter to see.
oh ok. to answer your question. Yeah.
This is Barb can you still hear me? Yep we can hear you Barb.
okay because since
Jackie’s from Detroit I wanted to also I think the other thing is since you’re
with the Department of Mental Health so this initiative was focused on
recruited IPFs in the three states and all three states have been promoting the
READMIT tool and in Michigan the group of IPFs that we work with here all were
very excited about it, but I think the challenge I’ll just talk about a little
bit of a challenge was trying to write it into the EHR so it was easy for staff
to use so as Jon said it’s sort of pending we’ve got some buy in but I
think you know sometimes those EHRs can be a little challenging for people, you know
try and put new things into they all were very excited to see that it was
targeted the IPFs and not just a general medical risk stratification but you know
we’re trying to test it with one of our our IPFs that we’re working with right
now and the only other thing I can speak to overall through our 3-4 years of this
initiative, we had to keep readmission rates with IPFs that we worked with a
below a baseline rate and all three states did well in that area. It was little
challenging for some of us but that was our overall goal and as a region we were
able to maintain that goal throughout the charge of this this particular task
that we have and that was done through technical assistance, education and
supporting IPFs and the readmission was like. Thank you. This is Lisa, from Stratis Health and I think that was a really great question is there data to
support use of these tools and no because it takes up to 17 years to
get data and research into practice. We’re just doing some innovative work to
try to put things into practice now that we can test, so it’s practice based
evidence instead of evidence-based practice. okay.
That’s a great point Lisa, but it is you know I really like what you guys did with it Jon, I mean that’s the way that’s going to be the next step, to getting it to the next step,
is making it so that it’s user friendly and intuitive and so on so that it
becomes easy to integrate easier to integrate into work flows. And Candy
I’ll say that Ross Gatzke, who works with us here in Wisconsin, has been in touch
with researchers on several occasions to let them know where we are, what we’re
doing with it and they’re very supportive and have indicated an
interest in we are trying to maintain contact, you know with the folks who
created the model. Great, thanks Jon all right anybody else have any questions, or
comments or anything. All right well hearing nothing, we’ll
give you all about seven minutes back into your day then and we thank you very
much for participating in this in our last webinar with you in this initiative
and also thank you for your ongoing participation and work to reduce
readmissions in inpatient psychiatric facilities. We know we certainly
acknowledge it’s no easy task. So thank you very much everybody. Have a great day.
You too. Thank you.

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