Healthcare Business Review

Advertise

with us

  • Europe
    • US
    • EUROPE
    • APAC
    • CANADA
    • LATAM
  • Home
  • Sections
    Business Process Outsourcing
    Compliance & Risk Management
    Consulting Service
    Facility Management Services
    Financial Services
    Healthcare Construction
    Healthcare Digital Marketing
    Healthcare Education
    Healthcare Marketing
    Healthcare Procurement
    Healthcare Staffing
    Medical Transcription and Translation
    Medical Transportation
    Psychological Services
    Radiology
    Waste Management
    Business Process Outsourcing
    Compliance & Risk Management
    Consulting Service
    Facility Management Services
    Financial Services
    Healthcare Construction
    Healthcare Digital Marketing
    Healthcare Education
    Healthcare Marketing
    Healthcare Procurement
    Healthcare Staffing
    Medical Transcription and Translation
    Medical Transportation
    Psychological Services
    Radiology
    Waste Management
  • Contributors
  • News
  • Vendors
  • Conferences
  • Awards
×
#

Healthcare Business Review Weekly Brief

Be first to read the latest tech news, Industry Leader's Insights, and CIO interviews of medium and large enterprises exclusively from Healthcare Business Review

Subscribe

loading

Thank you for Subscribing to Healthcare Business Review Weekly Brief

  • Home
  • Contributors

Utilizing Care Management to Reduce Length of Stay and Improve Patient Outcomes

Healthcare Business Review

Jonna Jenkins, Vice President of Patient Care Services/Chief Nursing Officer, Hutchinson Regional Healthcare System
Tweet

Patients diagnosed with chronic disease processes are some of the largest consumers of healthcare. While healthcare utilization is high, outcomes do not reflect that. Many individuals with chronic diseases are not given a clear expectation of how their disease will progress and what they and their families can expect. Clinicians understand that from initial diagnosis it would be valuable to start the conversation related to palliative care. However, people that do not work in healthcare are often afraid of the term palliative care as they associate it with not treating their disease. Within my organization we decided to try changing the nomenclature. Our goal was to see if we could help our patients have a higher quality of life, spend less time in the hospital, and begin to prepare them for what the end-stage process of what their disease might look like.


We experienced a change in the leadership of our care management team and decided to use this as an opportunity to develop new partnerships and change the way we deliver care to our patients with chronic diseases. As the CNO, one of our long-tenured ICU RN’s came to me asking how we could start a palliative care program. He shared with me that we had a patient with a chronic disease that had dozens of admissions over a three year period. Upon speaking with the patient and the family he felt they did not have a realistic idea of what their disease progression would look like. This led to many admissions to the hospital including the ICU. I knew that we had to do something to better serve this patient population and empower our clinicians to see changes they believed would lead to increased patient satisfaction and more time for patients with their families outside of the hospital setting.


We pulled together a multidisciplinary team of clinicians including hospitalists, nurses, care managers, social workers, and leadership. We discussed the hesitance of patients and providers to discuss palliative care. An idea was thrown out to call our team, The Chronic Disease Management (CDM) Team rather than the Palliative Care Team. Our hope is that the name change will encourage people to participate. Now that we had a name it was time to put some processes in place. How would we have patients referred to us? Who would the provider be? How would we manage patients in the hospital and post discharge? What chronic diagnosis would we start with to build a strong and sustainable program? All of these questions and more needed to be answered.


How would we have patients referred to the team? This would have to be a dual approach. Ideally, the primary care physician would refer all patients with a newly diagnosed chronic condition. Early enrollment would increase patient buy-in for the process leading to improved quality of life for a longer period. 


However, we also had a patient population that had been diagnosed already and were in differing phases of their disease process. Patients that were hospitalized with either a primary or secondary diagnosis that fit into our program would also need a referral.


We will work with admitting physicians to provide education on the new program, starting with the hospitalist group as they admit the majority of patients. We will work with our nursing informaticists to not only create the referral order but also a cheat sheet for providers. Working to make the process as smooth as possible for the providers should help with enrollment in the CDM program.


Who would fill the role of provider? The multidisciplinary team decided that an advanced practice nurse would be a good fit in our new program. This individual would be employed by our hospitalist group and would work closely with a nurse navigator that would be employed by the hospital. These two roles will be critical in the success of this program. As a team they will be helping our patients and families develop and implement plans to live with chronic diseases as well as plan for the future.


Our Goal was to See if we Could Help our Patients have a Higher Quality of Life, Spend Less Time in The Hospital, and begin to Prepare Them for What The End-Stage Process of What their Disease might Look Like


Managing patients both as inpatients and post discharge will be important tasks for our team. As patients and families develop trusting relationships with the CDM team, their care will be managed in a way that increases their quality of life and helps them to understand what the future might hold. When the patients are discharged the RN navigator will follow them to monitor for signs and symptoms that could lead to readmission. The goal is to manage symptoms and prevent readmission.


We decided to start with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF). Out patient monitoring would include weight gain, pulse oximetry measurements, blood pressure measurements, and periodic phone check-ins. Once patients are enrolled with the CDM Team they will be given portable pulse oximeters, portable blood pressure devices, and scales, along with instructions on how, when, and why to record their results at home. As we grow and develop the program our goal will always be to provide the best, most holistic care.


Weekly Brief

loading
> <
  • Current Issue
  • Current Issue

Read Also

Improving Quality through Strong Patient-Provider Relationships

Improving Quality through Strong Patient-Provider Relationships

Orlene St. Hill, Quality Director, AdvantageCare Physicians
READ MORE
Challenging the Status Quo to Improve Patient-Centered Care

Challenging the Status Quo to Improve Patient-Centered Care

Emma Monaco, Director, Post-Acute Strategy, Business Development Operations and Physician Relations, Marketing, Prime Healthcare
READ MORE
Turning a Bad Moment into a Better One

Turning a Bad Moment into a Better One

Alexia Spizzirri, Director of Patient Experience and Employee Engagement, St. Bernard Hospital
READ MORE
Elevating Nursing through Compassion and Care

Elevating Nursing through Compassion and Care

Lena Gorman, Nursing Case Manager, Faith Medical Services Inc
READ MORE
In the Future, Robots Will Replace Wound Care Doctors

In the Future, Robots Will Replace Wound Care Doctors

Kevin Orsak, Wound Care Program Manager, UT Southwestern Medical Center
READ MORE
Where Science Meets Beauty: The Medical Aesthetics Industry

Where Science Meets Beauty: The Medical Aesthetics Industry

Roger Kapoor, Senior Vice President, Beloit Health System
READ MORE

In the Future, Robots Will Replace Wound Care Doctors

Kevin Orsak, Wound Care Program Manager, UT Southwestern Medical Center

Where Science Meets Beauty: The Medical Aesthetics Industry

Roger Kapoor, Senior Vice President, Beloit Health System

Distraction in Digital Therapy

Beverly Wertheimer, PsyD, DMin, LCSW, Psychotherapist-Adolescent and Family Mental Health, Clinical Advisory Board Member, Daybreak Health

Navigating Quality, Safety, and Leadership in Healthcare

Christina Huitt, Sr. Director of Quality, Caromont Health
Loading...
Copyright © 2025 Healthcare Business Review. All rights reserved. |  Subscribe |  Sitemap |  About us |  Newsletter |  Feedback Policy |  Editorial Policy follow on linkedin
CLOSE

Specials

I agree We use cookies on this website to enhance your user experience. By clicking any link on this page you are giving your consent for us to set cookies. More info

This content is copyright protected

However, if you would like to share the information in this article, you may use the link below:

https://pathology-services.healthcarebusinessrevieweurope.com/cxoinsight/utilizing-care-management-to-reduce-length-of-stay-and-improve-patient-outcomes-nwid-1383.html