‘Innovation advisers’ chosen for ideas to improve health care

January 21, 2012

A New York hospital is testing a new approach to fight obesity. A Boston hospital wants to try a new nursing model. A Montgomery County primary-care clinic plans to expand its pharmacy program that gives one-on-one medication counseling to patients with chronic illnesses.

The people who created these programs are among the first 73 “innovation advisers” chosen by federal health officials this month to experiment with ways to provide better health care and reduce costs. Funded with $6 million from the health-care overhaul act, the initiative is one of the first programs of the new Innovation Center at the federal Centers for Medicare and Medicaid Services, known as CMS.

The advisers are meeting in Baltimore starting Monday for initial training and orientation as part of a year-long commitment, officials said. The health professionals include doctors, nurses, hospital executives and public health and policy experts from institutions in 27 states and the District. The home organizations receive stipends of up to $20,000 to cover some of the costs, such as travel.

In the Washington region, the professionals include Rosemary Botchway of the Primary Care Coalition of Montgomery County; Stephanie Bruce, a geriatrician at Washington Hospital Center; and Len Nichols, a health economist at George Mason University.

The overall goal of the CMS Innovation Center is to find new ways to improve health and lower costs, said Joe McCannon, a senior adviser. “That’s the North Star for every program we’re introducing,” he said.

Some Republicans have questioned the value of investing in experimentation to produce results at a time of limited resources.

Under the program, the advisers work on projects in their respective institutions. The goal is for them to become change agents at their home organizations, while also providing CMS officials with new ideas and approaches. CMS will work with them through the year to refine the projects and help “get some traction,” McCannon said. If the projects are successful, the ideas could then be applied more broadly, such as to Medicare and Medicaid.

Officials intend to select a second group of advisers in the spring, for a total of about 200 professionals.

The projects fall into several categories. Some are aimed at reducing unnecessary readmission to the hospital.

For patients, the transition from hospital to home is often difficult to manage. Many need help understanding their hospital discharge instructions and medication instructions, and don’t follow up with a primary care doctor. As a result, many wind up back in the hospital.

Another group of projects targets ways to reduce infections, medication errors and other types of harm in hospital settings. Other pilots seek to improve coordination of patient care, such as better communication among nurses and doctors in the hospital and better management by everyone involved in a patient’s care.

Continuity in nursing care

At Massachusetts General Hospital in Boston, Barbara Blakeney, whose title is innovation specialist, wants to create a new position, that of attending nurse. The nurse would not be involved in direct patient care, such as changing dressings, but would have primary responsibility for making sure that everything that has to happen for a patient does in fact take place, she said.

That could mean contacting the patient before arrival in cases of planned admissions, and following up on the phone after discharge. It could also mean ensuring that all hospital tests are performed and information is handed off seamlessly between shifts, she said. To provide patients more continuity, attending nurses would work eight-hour shifts over five days instead of 12-hour shifts over three days.

In Montgomery County, the pharmacy counseling began two years ago at a Gaithersburg clinic, one of 12 safety clinics that are part of the Primary Care Coalition. One-on-one counseling with pharmacists has helped patients take their medications correctly for chronic conditions such as diabetes, hypertension and high cholesterol, said Botchway, who heads the coalition’s Center for Medicine Access.

The plan is to expand the pharmacy counseling to a clinic in Wheaton, she said.

Bruce wants to develop tele-monitoring of Washington Hospital Center’s homebound seniors. At George Mason University, Nichols is developing business models that show physicians and hospitals how they can be successful under the health-care overhaul.

Reducing the obesity stigma

On Long Island, Diane Curley wants registered nurses to identify people who are at risk for unhealthy weight whenever they enter the health system of Catholic Health Services of Long Island. It includes six hospitals and three nursing homes. She hopes to start the pilot at St. Catherine of Siena Medical Center in Smithtown, where Curley is the performance improvement coordinator.

A person’s weight is almost always taken as part of any health assessment, whether he or she is having scheduled surgery, a routine screening or an emergency room visit, Curley said.

Curley’s idea is for registered nurses to talk to patients about their weight when that evaluation takes place. The nurse would inform patients if their weight is normal or unhealthy. If the person is obese, the nurses would explain how unhealthy weight affects other medical conditions, offer a list of questions that patients can ask their doctor, and direct them to online resources.

Patients are routinely asked whether they smoke and whether they feel safe in their homes, among other questions. By talking about weight as part of that evaluation, “it takes away the stigma from obesity,” Curley said. “It’s a health-care problem, just like any other health-care problem.”

Talking about weight may seem like a small step. “But it can have a big impact, because nobody does it now” in that context, she said.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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