Improved care, new skills result from ‘college’
Improved care, new skills result from college’
Participants study their own practices
Each participant in the Managed Care College at Henry Ford Health System in Detroit designs and completes a clinical improvement project within nine months.
"Our aim is not only to improve care for the patients we are taking care of now, but to help our professional work force master a new set of skills and the confidence they need to continually improve care for our members," says John J. Wisniewski, MD, MHSA, director of the program.
Typically, an interdisciplinary team that cares for the same group of patients will take on a project to improve care of those patients.
Here are some of the projects the teams have completed in the past:
• A physician and a nurse from an ambulatory primary care clinic looked at how they managed patients with chronic congestive heart failure. They conducted an assessment of their practices and outcomes and found that most of the patients were not getting any real education on how to manage their disease. For instance, patients did not know how to monitor their weight, what symptoms signaled an exacerbation in their condition, or self-management techniques. They found that some medications being prescribed were not always the most effective, and that some of the record keeping and monitoring in the clinic was not as good as they would prefer.
The team set up self-management classes for patients and changed the medication for patients who were not receiving the recommended optimal doses or the right medication.
"In addition to improving care for this set of patients, the physician and nurse learned lessons about teamwork and went from a more passive role of working within existing structures to an active role in shaping processes," Wisniewski says.
• A team from a hospice program found that its use of pain management medication varied among patients and physicians. The team studied the cost and lack of efficiency involved in varying doses as well as the potential for suboptimal patient dosing. They came up with a way to standardize and improve pain management.
• The treatment team at an inpatient geriatric unit found that a large number of elderly patients had active urinary tract infections that were not picked up immediately or not treated adequately. They instituted a whole range of interventions that included improvements in catheter insertion decision making, setting the optimal intervals for medications, and even designating cranberry juice as the default fruit juice on the meal trays.
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