Transcript Providence Centralia Hospital - Washington State Hospital

PROVIDENCE CENTRALIA
HOSPITAL
EMERGENCY DEPARTMENT
COMMUNITY ACCESS PROJECT
Cindy Mayo, Chief Executive
ED Community Access Project
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Lack of primary care access in Lewis County
Unemployment rate exceeds 14%
Community (based on hospital mission) sees
“Providence” as provider of care to community (via
Emergency Department)
Data reviewed in 2008 demonstrated 14,297
patients in ED with triage levels 4 or 5 status, of
which 25% were charity and 24% Medicaid (this
included visits for medical as well as dental issues)
Cultural/generational issues related to ED utilization
for primary care
Collaborative Solution Involved
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Valley View – Federally Qualified Health Clinic
Private practice physicians and dentists
Washington State Department of Social and Health
Services
Behavioral Health Resource Services Network
CHOICE Regional Health Network
Hospital based leaders
Community Ministry Board (past-chair)
Lewis County Emergency Department Physicians
Public Health Department - MD
Target Patient Population
and Goals
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Reduce Level 4 and 5 triage emergency visits by
10% from 2008 baseline data
Reduce ED visits for dental issues by 10%
Reduce ED patients with repeat/multiple visits for
dental issues by 10%
These patients have chronic diseases, behavioral
health issues, drug seeking behaviors, dental issues
and inability to establish primary care home
Solutions
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Valley View Walk In Clinic – on hospital campus; 7
days a week 12:00pm – 10:00pm
Advertised in local paper and in local school system
Emergency Department post discharge follow-up to
Valley View Health Center – Valley View Walk In
Clinic – Valley View Dental Center
Dental referral began June 2009 (quasi-case
management process)
Walk In Clinic opened December 2009
Walk In Clinic space donated to Valley View by
Providence Centralia Hospital
Results
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2010 – Walk In Clinic volume 8,923 (5,794
patients), 32% uninsured, 34% Medicaid
Drop in hospital triage level 5 of 34%, triage level
4 of 15% (2010 as compared to 2008 baseline)
Post ED discharge/referrals to Valley View (with
appointment); N=1,612 – 76% kept appointments
Results (cont’d)
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Post ED referral for dental care; N=113 (with
appointments) 80% kept follow-up appointment
Reduction of ED visits for dental patients by 7% (18
month trend)
Patients with repeat (multiple) dental visits reduced
by 21% (18 month trend)
ED Consistent Care Program
(EDCCP)
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Consistent Care is a proactive intervention program
designed to guide treatment decisions for
individuals with unresolved and complex health care
needs
Innovative and collaborative structure to improve
health of vulnerable people by effectively
managing co–occurring chronic conditions and
behavioral health issues.
ED Consistent Care Program
EDCCP (cont’d)
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Collaborative includes PSPH and PCH Emergency
Centers, ED physicians, CHOICE Regional Health
Network, Department of Social and Health Services
Review and Coordination Program, primary care
physicians, community health clinics, chemical
dependency center/Behavioral Health staff (if
available)
Patient Population
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High users – 2 visits/month or 4 visits in 6 months
Complex cases – chronic pain (head, neck, back,
abdomen, teeth)
Mental, behavioral and social issues
Chronic disease management (hypertension,
diabetes)
Consume resources ( example staffing and
diagnostic exams) due to threatening behavior
Visits unnecessary, preventable, best treated in
outpatient (non emergency) setting
High frequency of drug seeking behavior
Interventions
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Alerting patients to their heavy (inappropriate) use
of the ED
Establishing and sharing patient plan of care
among clinicians
Personal case management by community health
workers
Collaborative approach to patient specific
treatment decisions based on shared plan of care
among the patient and all clinicians
Interventions (cont’d)
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Data sharing among hospitals, providers, and
payers to form a complete picture of patient life,
behaviors and care needs
Team usually consists of ED Medical Director, RN
Nurse Coordinator, Behavioral Health/Chemical
Dependency Specialist (if available), CHOICE
provides Administrative Coordinator, Community
Health Worker, Social Services/Intake Referral
Coordinator (administrative support)
Results
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PSPH – Most mature program with demonstrated
results – in targeted population reduced ED visits by
50%, and saved on average $9,000 in charges per
enrolled patient year, with an estimated
$5,662,000 in combined saved charges (since
program inception).
Results (cont’d)
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CHOICE calculates combined arrival costs (hospitals,
CHOICE and Primary Care) to operate six
programs to be $400,000 depending on case mix
and complexity. If 750 high users enrolled in
EDCCP this could result in 4,200 fewer unnecessary
ED visits and reduced charges of $7.3M in our
region per year
Current Participating Facilities: Providence St. Peter
Hospital, Providence Centralia Hospital, Mason
General Hospital, Mark Reed Hospital, Grays
Harbor
Thanks to
Jackie Brown, Sr Director
Emergency Services PSPH &
Kristen West, Executive Director CHOICE