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Recognizing that medical problems and behavioral health issues are often intertwined, payers and providers are coordinating behavioral health and medical health case management.
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As the National Committee for Quality Assurance hopes that all-cause readmission rate reporting by health plans will assist in creating more consideration of patient care across the continuum, the National Quality Forum (NQF) hopes a new measurement framework for multiple chronic conditions will likewise help improve care in and out of the hospital.
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A collaborative approach in which primary care physicians and nurse case managers work with patients with depression has resulted in a 50% improvement of scores on a depression questionnaire among patients who were part of a pilot project at UC Davis Family Medicine in Sacramento.
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To keep a lid on costs, health care policy experts recognize that hospitals need to find more effective ways to manage transitions. The care coordination piece can be particularly problematic in the fast-paced ED setting, and yet it can make a big difference in determining whether a patient receives appropriate follow-up after an acute event and whether he or she is back in the ED within days or weeks with another acute exacerbation of the same issue.
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Since Fallon Community Health Plan in Worcester, MA, began integrating medical case management and mental health case management, members in the health plan's Medicaid HMO with medical issues have experienced fewer inpatient days and emergency department visits and those in behavioral health have less need for unplanned medical care, says Dena Miller, RN, MSN, vice president of clinical innovation and implementation for the health plan.
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If an emergency department (ED) patient with impending sepsis is discharged, returns hours later in septic shock, and dies or develops organ failure, "you're likely to get sued," warns Bruce Wapen, MD, an emergency physician with Mills-Peninsula Emergency Medical Associates in Burlingame, CA.
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Waiting time has always been the number one complaint against hospital emergency departments (EDs). In an attempt to address the waiting issue, hospitals recently began allowing patients with nonemergency conditions to "schedule" their ED visits through the Internet and then wait at home until their "projected treatment time" in the ED.
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Emergency medical services (EMS) crews are all on assignments, it's rush hour, the cardiologist hasn't called back, or the transfer center is waiting for approval before assigning a bed. These are all valid reasons for delays in transfer of a patient with an ST-elevation myocardial infarction (STEMI), says Kevin Brown, MD, MPH, FACEP, FAAEM, principal with Brown Consulting Services in Armonk, NY, and former director of the department of emergency medicine at Greenwich (CT) Hospital, but if any of these delays occur, times should be documented by the emergency physician (EP).
