The 81 new grants worth $772 million will be administered by the Center for Medicare and Medicaid Innovation (CMMI). Including 26 grants announced in May, the government plans to dispense a total of $895 million to grassroots healthcare improvement projects over the next three years. HHS said it expects that these initiatives will save the government $1.9 billion--about twice what they cost.
One example of a winning innovation is the program that Christus St. Michael Health System in Texarkana, Tex., has designed together with the Community Long-Term Care Facility Partnership Group and Incarnate Word University. The initiative, termed the Integrated Nurse Training and Mobile Device Harm Reduction Program (INTM), will receive $1.6 million in HHS funds and is expected to save $3.5 million.
According to the grant announcement, "The INTM will train nurses to recognize early warning signs of congestive heart failure and sepsis in Medicare beneficiaries in nursing home facilities and patients in hospitals who are vulnerable for certain preventable conditions. This training, in combination with computerized clinical decision support systems that guide nurses through evidence-based protocols once symptoms are detected and mobile devices (tablets) loaded with clinical support system software, is anticipated to result in a 20% reduction in readmissions from nursing home facilities for CHF and sepsis and fewer failure-to-rescue situations for those patients who are admitted to the hospital."
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The LTC Facility Partnership Group includes 11 nursing homes with a total of about 800 beds, said Christus St. Michael's chief medical officer, Michael Finley, in an interview with InformationWeek Healthcare. The nurses at these facilities, and some at the hospital, are already equipped with iPads, he said. When the decision support software is loaded on these devices, they will include evidence-based protocols for treating patients who have CHF, sepsis, or one of several other conditions.
When a nurse recognizes that a patient has such a condition, she can contact one of the eight Christus St. Michael nurse practitioners who have been assigned to the long-term care (LTC) facilities. These NPs, based at the hospital, can go see the patient at the nursing home, consult with a physician supervisor, or have the patient brought to the hospital, Finley said.
If a patient begins deteriorating in the hospital, a nurse will enter the patient's room number and the condition they're checking on, and the software will send an automatic alert to the hospital's rapid response team.
A total of 1,300 nurses, LPNs, and medical assistants will be trained to deal rapidly with signs of decompensation. Of those, 400 work at the nursing homes, Finley said.
He expects the project will save money by preventing readmissions and by making sure that if patients are hospitalized, they aren't so sick that they have to be sent to the ICU and put on a ventilator. For example, if clinicians spot a urinary tract infection early enough, it need not lead to sepsis and a potentially catastrophic situation.
In New York, the Bronx regional health information organization (RHIO) will administer a $12.8 million HHS grant and will use it to save an anticipated $15.4 million. Montefiore Medical Center, a member of the Bronx RHIO, Weill Cornell Medical College, and Bronx Community College are co-recipients of the grant.
The grantees will create an entity called the Bronx Regional Informatics Center within the RHIO. The informatics center "will provide information as a driver to improve quality, improve patient outcomes and reduce cost, and train healthcare workers on quality improvement efforts on behalf of our members," said Charles Scaglione, executive director of the Bronx RHIO.
Using the RHIO's clinical data, the center will create a unified patient registry and apply analytic software to help the RHIO's members--which include several large institutions and about 2,000 physicians--do care management.
In addition, the center will help train additional healthcare workers so they can help RHIO members proactively intervene to improve population health. The community college already has an HHS grant to train health IT technicians; some of these students will serve internships at the center, which will also hire some of them.
The HHS grant, Scaglione said, "will allow us to figure out how to utilize the RHIO data. This is something that RHIOs across the country are facing: how do you get all the providers to access the data in a way that's meaningful to their workflows? This will help us address that challenge."
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