Bridging Sites of Care
Skilled nursing facility training team.
MaineHealth’s Anne Cannon and the ACO’s Melissa Caminiti and Beth Wilcox at Harbor Hill Center in BelfastTo meet the challenge of reducing admissions and emergency department utilization, the MaineHealth ACO is looking beyond the traditional confines of medical practices and hospitals. During 2017, our clinical collaboration with MaineHealth Healthy Aging and the MaineHealth Cardiovascular Service Line pointed to a new opportunity: introducing skilled nursing facilities to a heart failure protocol with the potential to reduce the number of patients transferred back to the emergency department. Data showed that a large number of heart failure exacerbations at skilled nursing facilities led to ED visits and readmissions, despite safe, effective and simple treatment that facilities could administer on-site. The ACO and MaineHealth set out to train more than two dozen skilled nursing facilities on the protocol and support its implementation.Heart failure protocol training in Belfast
The proposed protocol was based on one pioneered by MaineHealth for the home health setting. It establishes a “target weight” for the heart failure patient when his or her condition is well controlled. A gain of four pounds over the target weight triggers the protocol, particularly if the weight gain is accompanied by other symptoms of exacerbation. The patient’s provider is consulted and dosage of diuretics is typically doubled from the baseline. In most cases, use of the protocol controls the exacerbation within 48 hours.
The ACO and MaineHealth adapted the home health protocol and began piloting it at Seaside Rehabilitation in Portland, a member of the Senior Living Collaborative (SLC), a group of over 40 nursing homes in the MaineHealth footprint that convene to network and share best practices. Soon, other members of the SLC came on board. By the end of 2017, 17 facilities had adopted the protocol. Data collected from a sample of seven of those facilities showed impressive results. During 2017, they maintained a heart failure readmission rate of 9.1 percent, well below the national average of 20.4 percent. Based on these data, the ACO estimates that 20 patients avoided readmission at a cost savings of $200,000.
Today, the ACO and MaineHealth are spreading the protocol to a wider network of skilled nursing facilities that are enthusiastic about its potential to improve patient care. By the end of 2018, we expect 25 Maine facilities will have adopted this simple, effective protocol.
Training team with heart failure training attendees