Becker's Hospital Review

35 Executive Briefing: The Patient-Centered Hospital Home H ospitals across the country are look- ing for innovative ways to improve the delivery of healthcare to lower costs, increase patient satisfaction and en- hance patient outcomes. With mounting evidence that the patient-centered medical home model is effective on all of these fronts, hospitals should consider applying the prin- ciples of this primary care model to the inpa- tient hospital setting in a new model for care: the patient-centered hospital home. Understanding medical homes To understand the patient-centered hospital home, one must first understand the pa- tient-centered medical home. According to a 2007 report authored by several national physician organizations, the PCMH is de- fined as "an approach to providing compre- hensive primary care for children, youth and adults. The PCMH is a healthcare setting that facilitates partnerships between individ- ual patients and their personal physicians, and when appropriate, the patient's family." The goal of a PCMH is to improve health- care by transforming the way primary care is organized and delivered. Providing pri- mary care that prevents illnesses and rec- ognizes and treats health problems early can improve health outcomes, help patients better manage chronic diseases and lower costs for patients, providers and payers. In recent years, the PCMH has gained wide- spread favor. Provisions of the 2010 Patient Protection and Affordable Care Act included strategies for enhancing primary care and medical homes. According to the National Academy for State Health Policy, 43 states had adopted policies and programs to ad- vance medical homes as of April 2013. And many PCMHs are delivering results. For example, BlueCross BlueShield of Michigan's PCMH saved an estimated $155 million over its first three years. In Boston, a PCMH serving seniors increased rates of immunization, mammography, colorectal cancer screenings and eye exams. And a 2012 review of 46 medical home initiatives nationwide concluded that the "PCMH im- proves health outcomes, enhances the pa- tient and provider experience of care, and reduces expensive, unnecessary hospital and emergency department utilization." Defining the patient- centered hospital home Unfortunately, the PCMH does not impact the way care is delivered in the inpatient setting. That's why the patient-centered hospital home is so important. The PCHH is an approach to providing highly effective, coordinated care to pa- tients during a hospital stay. The PCHH is a hospital-based care setting that provides a physician-led, multidisciplinary and team- based system of patient-centered care that guides the patient throughout the entire hos- pital experience, from initial diagnosis and admission through discharge and beyond. To put it simply, the PCHH applies the func- tions and attributes of the PCMH model to the inpatient setting, with the goal of mak- ing the entire continuum of hospital-based care safer, more efficient and effective — as evidenced by better patient outcomes and satisfaction and lower costs. PCHH: Why now? Accountable payment models and value- based purchasing require highly coordi- nated, integrated care — something many hospitals struggle to achieve. Most hospi- tals function in a fragmented manner with different departments operating in self- contained "siloes." Rife with inefficiencies, miscommunications and delays, this oper- ating model can be costly both in terms of actual dollars and patient outcomes. For example, in a typical hospital, the pro- cess of caring for an elderly patient with a hip fracture goes something like this: The patient receives an X-ray and pain medication in the emergency department. Once the ED physician diagnoses the hip fracture, he or she hands off the patient to a hospitalist who admits the patient, conducts an assessment and requests a consulta- tion with a surgeon. It may be several hours before the surgeon is able to see the pa- tient, obtain clearance for the surgery and consult with the anesthesia department to make sure the patient is surgery-ready. At that point, the anesthesiologist may need to run additional tests prior to surgery. In this scenario, it may be 36 hours before the pre-surgical process begins. In fact, many hip fracture patients face a costly three-to-five-day inpatient wait for surgery. In 2011, the mean cost for a hospital stay for a hip fracture was $15,400, according to the Healthcare Cost and Utilization Proj- ect. And for high-risk, older patients, longer hospital stays increase the chances of in- fection, complications or even mortality. Ac- cording to the Centers for Disease Control and Prevention, one out of five hip fracture patients dies within a year of their injury. PCHH solution If, however, the hospital adopts a PCHH approach to care, it can implement more ef- ficient protocols and pathways for manag- ing high-risk, high-cost cases with greater focus on the entire inpatient continuum. In a PCHH model, after the ED physician confirms a hip fracture, he or she immedi- ately notifies the anesthesia and hospital medicine teams. The hospitalist admits the patient using more standardized order sets, and the anesthesiologist notifies the orthopedic surgeon, schedules the sur- gery and does a pre-operative risk assess- ment before the patient heads to surgery. In many cases, the patient can receive surgery the very same day. This rapid hip protocol improves commu- nication among providers and creates a streamlined patient experience. The mod- el has been shown to dramatically lower length-of-stay, reduce the likelihood the patient will need a blood transfusion, and lessen the risk of post-operative infection, consequently cutting the patient's rehabili- tation time. These improvements not only save the hospital time, money and bed ca- pacity, they help ensure better outcomes. Benefits of PCHH In general, when the PCHH approach is successfully applied to hospital-based care, benefits can include: • Preventing unnecessary or repetitive testing Building the Patient-Centered Hospital Home A New Model for Improving Hospital Care Sponsored by

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