Transforming Care in the Carolinas

The American Hospital Association recently highlighted a Duke Endowment-funded program by NCHA and the South Carolina Hospital Association to optimize care transitions and increase patient engagement. The associations collaborated to provide a forum to share best practices and data, as well as offer education and technical assistance to the participating hospitals. The $5 million grant ran from 2016 to 2018.

Spurred by grant funding and collaboration, 15 hospitals in North Carolina and South Carolina worked to improve the patient experience, enhance care coordination and decrease avoidable readmissions. Hospitals could implement customized approaches but were required to incorporate three actions when caring for inpatients, according to Trish Vandersea, NCHA’s director of population health initiatives.

Participants were required to perform: 1) risk assessments; 2) follow-up phone calls within three days of discharge, home visits within seven days and follow-up appointments within 14 days for high-risk patients; and 3) phone calls for moderate-risk patients. Hospitals also monitored patients’ health confidence to measure their engagement in their care and to better understand patient needs.

In a special study of 78 patients at Carolinas HealthCare System Blue Ridge in Morganton, utilization in emergency, inpatient and observation care was reduced by 48%. Read more about the program in The Value Initiative: Redesigning the Delivery System.

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