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Henry Ford Health System’s ‘No Harm Campaign’ Reduces Harm and Saves Lives

The “No Harm Campaign” at Henry Ford Health System (HFHS) in Detroit integrates national, local, and homegrown efforts into one system-wide initiative to reduce harm. With an ambitious goal to decrease harm events system-wide by 50% from 2008-2013, the No Harm Campaign focuses on enhancing the culture of safety, improving the quality and clarity of clinical communications, identifying top causes of harm overall and at individual points on the continuum of care, and redesigning care to eliminate common causes of harm.

HFHS uses a broad definition of harm: any unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization or that results in death. Such injury is considered harm whether or not it is considered preventable, resulted from a medical error, or occurred within a hospital.

Harm reduction is measured by a comprehensive set of 27 measures across six categories: infection-related, medication-related, procedure-related, care delivery, employee, and other types of harm. These harm measures, comprised of hundreds of medical codes, combine to create a unique aggregate global harm score. The global harm score for each hospital overall and by category is transparent to all stakeholders within the system in an effort to create and spread best practices for harm reduction across the system.

From January 2008 through December 2011, the combined inpatient harm rate system-wide decreased by 31% and system-wide mortality rate decreased by 18%. This reflects a reduction of 169 harm events/month even while adding a new hospital and increasing the total number of patient days in the period measured. Cost-savings of the No Harm Campaign are estimated to total $10 million over a 4-year period, a savings of 8-9% each year in costs.

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FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Henry Ford Task Force Reduces Catheter-related Bloodstream Infections in Hemodialysis Patients

The Henry Ford Medical Group in Detroit has a large dialysis program with high-risk patients; about 80 to 100 of these patients per month use a hemodialysis catheter for vascular access. Despite attempts to reduce catheter-related bloodstream infections (CRBSI) over a 3-year period, rates remained well above the national benchmark of 3.1/100 patient months. To address this issue, the Catheter Bacteremia Task Force was formed, involving Nephrology, Pharmacy Services, Infectious Diseases, Infection Control, and the Dialysis Administrator. This Task Force included the expertise and key leadership needed to make any potential intervention successful. The protocol involved instilling a gentamicin/trisodium citrate solution into the catheter lumen after each patient’s dialysis session.

Use of the antibiotic lock protocol decreased the average rate of CRBSI by almost 85%, avoiding an estimated 69 infections. The protocol was spread to three other dialysis units, resulting in a 24.5% reduction in mortality for dialysis patients. This improvement initiative reduced infections to below the national benchmark and reduced hospitalizations and unnecessary vascular access procedures which also translated into significant cost-savings.

For this innovative work, Henry Ford Health System won the Innovations in Healthcare Award in recognition of excellence in chronic kidney disease prevention and treatment.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Depression Care Curbs Rate of Suicides at Henry Ford

A quality improvement initiative for the Health Alliance Plan members who receive care at Henry Ford Medical Group resulted in dramatically bringing down the rate of suicide in its 200,000 patient population. Over 9 consecutive quarters, there were no suicides among the patients of the Perfect Depression Care Program of the Behavioral Health Services division of Henry Ford, in stark contrast to the 230 suicides expected in an average population of 100,000. The goal of the initiative was to completely redesign care delivery around the six aims outlined in the Institute of Medicine’s Crossing the Quality Chasm report–safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—in order to reduce the number of suicides to zero. The belief held by the program is that perfect depression care would result in no suicides—not just a reduced risk of suicide.


Excerpted from:
Depression Care Effort Brings Dramatic Drop in Large HMO Population’s Suicide Rate
Tracy Hampton, PhD
JAMA. 2010;303(19):1903-1905.
http://jama.ama-assn.org/content/303/19/1903.extract

“While physicians and other health care workers may not be ableto predict which of their patients will attempt suicide, theycan implement preventive strategies that markedly lower therisk of such tragedies. Now, one pioneering program has demonstratedthe importance of pursuing 2 key approaches at once: carefullyassessing patients for risk of suicide and adopting measuresto reduce the likelihood that a patient will attempt suicide.

The example comes from a quality-improvement initiative that succeeded in substantially bringing down the rate of suicide in a population of about 200 000 members of a large health maintenance organization (HMO). Through the second quarter of last year, the Perfect Depression Care program of the Behavioral Health Services (BHS) division of the Henry Ford Health System resulted in 9 consecutive quarters without any suicides, a dramatic contrast to the annual rate of 89 suicides per 100,000 members at baseline and approximately 230 suicides per 100,000 individuals expected in a patient population . . .”

Keywords: care team; depression; Henry Ford Health System; Michigan; Perfect Depression Care Program; prevention; quality improvement; rate of suicide;

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Worksite Complementary and Alternative Medicine Group Programs Reduce Chronic Pain

Henry Ford Medical Group experts in complementary and alternative medicine (CAM) have provided worksite programs since 2006 using research-proven CAM therapies. In an effort to improve employee health outcomes, the innovative approach focuses on group treatment and teaching self-care techniques. CAM protocols include chiropractic methods, needling acupuncture, electrical stimulation of acupuncture points, St. John neuromuscular therapy, movement re-education, and mind-body therapy. The Worksite Complimentary Alternative Medicine Programs first focused on back pain, followed by any type of neuromuscular pain, and recently expanded to address stress-related illness. In 2009 the “Stress- and Pain-Free Living” programs offered to Chrysler and Henry Ford Health System employees showed elimination of chronic pain in 45% of participating employees and improvement in 49% with stress-related chronic illnesses with 9% totally resolved (with no need for medication) at program end.


Stress and Pain-Free Living Program at the Worksite

http://henryford.com/body.cfm?id=53038

Aim
To improve employee health outcomes and decrease costs for self-insuring corporations in Michigan by delivering innovative, research-proven, onsite group wellness programs using complementary and alternative medicine (CAM) therapies. The Stress- and Pain-Free Living (SPFL) programs offered to employees of Chrysler and Henry Ford Health System in 2009 were designed to build on the successes of our previous award-winning group programs, “We’ve Got Your Back” program in 2007 for chronic back pain and “Pain Free in 2008” program for all chronic neuromuscular pain.

Measures
Participants reported their stress levels, as well as pain levels, on a 0-10 numeric rating scale before and after participating in the program. Other outcomes tracked included disability (Oswestry Disability Questionnaire), depression (PHQ-9), perceived stress (Perceived Stress Scale), and sleep quality (Pittsburgh Sleep Quality Index).

Changes
Group sessions (up to 84 per group) included education plus intervention for a total of 18-24 contact hours over a 6-7 month period:

  • Guided Relaxation for New Awareness: Learning to relax, breathe properly, to recognize and intervene with stress as well as automatic habits and patterns that have been supporting the persistence of chronic pain.
  • Somatic Movement Education for New Awareness: Simple movement routines to recognize and release over-contracted muscles, which is critical for reducing and eliminating pain.

Home Health Activities: Participants take responsibility for improving their condition by listening to guided relaxation CDs and doing somatic movement routines at home and at work to alleviate pain.
We expanded our partnerships to more Henry Ford Health System locations. This increased the number of employees served.

Results
A total of 421 Chrysler and Henry Ford Health System employees attended group sessions. These employees reported a total of 2,471 pain conditions at the start of the program. Back, shoulder, neck, knee, and hip were the 4 highest reported chronic pain areas.

Stress Elimination: 14% of participants reported elimination of stress by program end. On average, stress levels were reduced from 4.82 at pre to 2.45 at post on the 0-10 scale.

Pain Elimination: Research shows that once pain becomes chronic, it is resistant to intervention. In our previous programs at Chrysler and Henry Ford Health System (“Pain Free in 2008”), 35% of chronic pain conditions were eliminated. In the new Stress and Pain-Free Living programs, 45% of chronic pain conditions were eliminated. On average, pain levels were reduced from 3.73 at pre to 1.35 at post on the 0-10 scale.

Quality of Life Outcomes: Significant reductions occurred in disability, depressive symptoms, and perceived stress, and significant improvement occurred in sleep quality. Of 645 stress-related chronic illnesses reported by participants, 49% were improved and 9% resolved (i.e., completely under control with no need for medication) at program end.

Program Satisfaction: 92% of participants expressed satisfaction with the program and an interest in taking another workplace health program.

Time Involvement: We tested and showed that 18 contact hours offered to Henry Ford Health System employees was as effective at producing significant beneficial results as the 24 contact hours offered to Chrysler employees.

Next Steps/Lessons Learned
Online surveys to determine clinical eligibility for program participation and to facilitate collection of pre-program, interim program, and post-program data make future program development simple and efficient.

Communication and advertising methods enable us to reach a wide group of potential program applicants and participants in a short time period; worksite recruitment is ideal and fast.

Word of mouth advertising is continuing to fuel new programs. We filled 9% of this year’s Henry Ford Health System programs through referrals from previous participants.

Pain-Free in 2008: Worksite Complementary Alternative Medicine Programs

http://www.henryford.com/body.cfm?id=52277

Aim

In 2007, the “We’ve Got Your Back” program offered to groups of Chrysler employees experiencing chronic back pain resulted in elimination of back pain in 55% of the reporting participants at the end of the program. That workplace-based program used a hands-off group intervention involving complementary and alternative medicine (CAM) therapies. For 2008, we aimed to expand the number of chronic pain conditions addressed. The goal was to reduce or eliminate chronic pain in the back, hip, neck, shoulder, other limb joints, and headache, together in the same group of employees, many of whom had more than one pain condition to address. The new programs, offered under the umbrella name of Pain Free in 2008, employed a similar hands-off group approach using CAM intervention; the programs were available to Chrysler employees and expanded to be available to Henry Ford Health System employees.

Measures

• Self-reporting pain areas before and after program interventions.

• Outcomes measures for disability (Oswestry Disability Questionnaire), depression (PHQ-9), perceived stress (Perceived Stress Scale), and sleep quality (Pittsburg Sleep Quality Index).

• Patient satisfaction.

Changes

The Pain Free in 2008 program participants experienced a total of 24 contact hours over a 7-month period. Sessions included:

• Guided Relaxation for New Awareness (a language-based mind-body connection technique) and Somatic Movement Education for New Awareness (a non-languagebased mind-body connection technique).

• Assignment of home “wellness activities” included listening to Guided Relaxation CDs and performing somatic movement education routines. Participants tracked and reported their compliance daily.

• Group feedback from the homework assignments given at each session.

• A lecture/educational component.

We transitioned to online surveys for program eligibility, and pre-, mid- and postprogram health outcomes data collection. We modified the program time based on feedback from the two organizations, which wanted shorter sessions; original 2-hour group classes totaling 12 sessions were redesigned to 1.5-hour group classes totaling 16 sessions.

Results

• A total of 176 Chrysler and Henry Ford Health System employees attended the workplace group sessions (up to 60 per group). A total of 375 pain conditions were reported by the participating employees at the start of the program. Back, neck, hip, and shoulder were the four highest reported chronic pain areas.

• Pain Elimination or Reduction: 35% of pain conditions were eliminated by the end of the programs. Additionally, in over 76% of pain conditions, the pain levels were reduced by at least 20%. These results contradict research reports that once pain becomes chronic, it is resistant to intervention.

• Quality of Life Outcomes: Significant reductions occurred in isability, depressive symptoms, and perceived stress, and sleep quality significantly improved.

• Patient Satisfaction: 82% of participants expressed satisfaction with the program and an interest in taking another workplace health program.

Next Steps/Lessons Learned

The flexibility and effectiveness of this innovative model has the potential to reach many other southeast Michigan workforces and beyond. Specific tools allowed this program model to be easily implemented, tailored, and adapted:

• Online surveys to determine clinical eligibility for program participation and to facilitate collection of pre-program, interim program and post-program data.

• Workplace communication and advertising methods to reach a wide group of potential program applicants and participants in a short-time period; worksite recruitment was ideal and fast.

• Design of a structural pain program that will reach an even broader range of pain sufferers (beyond back pain).

• Effective measurements of program results were critical to this project’s success.

Results were reported to the organizations’ leadership on a regular basis which enabled timely resolution of any program issues and provided a high level of program support.

Team Approach:

This program was a joint effort between the Henry Ford Medical Group’s Center for Integrative Wellness (CIW), Health Alliance Plan (HAP)’s Purchaser Initiatives, Chrysler, and many Henry Ford Health System Departments and Centers including Employee Health and Wellness, Center for Health Promotion, Public Relations, Biostatistics, and the Center for Health, Education, and Wellness. CIW team members led the clinical design and execution of the program. HAP team members provided the program opportunities at Chrysler through the existing client relationship, in addition to the logistical, financial, and organizational coordination of the project. Henry Ford Public Relations coordinated all efforts to recruit employees; Employee Health and Wellness provided funding for several programs; the Center for Health Promotion assisted with health outcomes data collection; Biostatistics provided data analysis; and the Center for Health, Education, and Wellness provided oversight and monitoring of program content in partnership with the CIW. This model leveraged a cross-function of skills and synergies from all involved to build a highperforming, effective, and efficient program to serve the chronic pain needs of participating employees.

For more information about these projects, contact Dr. Robert Levine, Robert A. Levine, PhD, CHt, Director, Center for Integrative Wellness, Henry Ford Medical Group, (248) 342-7555, rlevine1@hfhs.org.

Keywords: alternative medicine, Detroit, CAM, chronic care, chronic pain, Chrysler, complementary medicine, evidence-based medicine, Henry Ford Health System, Michigan, safety, stress value

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel. 313.876.8709
Dangell1@hfhs.org
www.henryfordhealth.org

Patient-Centered Team Care: A Medical Home Model Designed for and with Patients

To improve the management of patients with chronic disease, Henry Ford developed an advanced medical home model in 2007 for ambulatory primary care, implementing the first phase at 3 sites. Each site identified 4-6 patients to serve as patient advisors to the multidisciplinary design team of physicians, nurses, medical assistants, customer service representatives, social workers, case managers, etc. The patient advisors selected the program name “Patient-Centered Team Care,” finding the Medical Home term too confusing, and helped to improve patient educational materials and the patient Plan of Care form used in clinic. To assess the effectiveness of the practice model, Henry Ford tracked chronic disease measures (e.g., low density lipoprotein, hemoglobin A1c, blood pressure, weight) before and after implementation of patient-centered team clinics. Patients showed improvement in low density lipoprotein and hemoglobin A1c after receiving case management services for 90 days or greater.


Patient-Centered Team Care: A Medical Home Model Designed for Patients http://www.henryford.com/body.cfm?id=53112

Aim

  • To include our patients in the design and implementation of care processes developed as part of the patient-centered medical home for our ambulatory primary care clinics
  • To implement patient-centered team care clinics and improve chronic disease mana™gement of adult patients

Measures

  • Chronic disease measures (e.g., LDL, hemoglobin A1C, blood pressure, weight, etc.) before and after implementation of patient-centered team clinics

Changes
Four patients at each of the three participating clinic sites agreed to serve as “patient advisor” to the multidisciplinary design teams. Patient advisors attended design team meetings held quarterly and were available for consultation between meetings for immediate feedback. Patient advisors were instrumental in the design of several practice changes:

  • Program Name and Patient Education Materials: Our patient advisors recommended against using the “medical home” term as part of our program name. They believed the general patient population would confuse the word “home” with “nursing home” care. With their input, we selected “Patient-Centered Team Care” and developed marketing/education materials to help communicate to the general patient population the benefits of team care. A series of plan-do-check-act (PCDA) cycles beginning in 2007 through October 2008 resulted in a finished package of patient education materials which are now distributed to new patients at the three clinics.
  • Patient Plan of Care: We developed a Plan of Care form to engage patients in their care and to introduce the patient to additional members of their health care team. Our patient advisors helped design the form and the communication process that physicians use to introduce each patient’s unique care team. The form has completed 16 PDCA cycles and is now part of the electronic medical record.
  • Chronic Disease Management: We designed and implemented case management interventions to meet the needs of high-risk patients. Our patient advisors strongly recommended that we establish mechanisms to ensure that communication between the case manager and physician was visible to the patient to further illustrate the concept of team care. Weekly meetings between case managers and physicians are held, with physician endorsement of the case manager’s first outreach to the patient if done outside of the office visit between physician, case manager, and patient.
  • Telemedicine for Heart Failure: We implemented a telemedicine service for patients with heart failure to assist case managers in monitoring patients’ symptoms in an effort to provide immediate interventions designed to avert emergency department (ED) visits and hospital admissions. Our patient advisors were included in the decision-making process, endorsing the selected vendor and implementation plan.

 

Results

  • Chronic Disease Measures: Patients showed improvement in key clinical metrics (e.g., LDL and A1c) after receiving case management services for 90 days or greater. However, patients did not show significant improvement in weight loss.

Next Steps/Lessons Learned

  • We are currently working with senior leadership to spread key medical home concepts and new interventions across other primary care sites. The participation of our patient advisors will continue to be the cornerstone of our change plan.
  • The key to our success is team work. We learned to value each other’s opinions and appreciate the unique skills and talent each person can bring to a team. We learned that everyone’s support or “buy-in” is essential before proceeding with a practice change or the change will not be sustained.

Keywords: ambulatory primary care, care team, chronic care, chronic disease management, Detroit, evidence-based medicine, Henry Ford Medical Center, medical home, Michigan, patient support, safety, telemedicine, treatment, value

Contact Information: Katherine Scher, Office of Clinical Quality and Safety, Henry Ford Health System, kscher1@hfhs.org.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System continually works to integrate web technologies into health care delivery. More than 80,000 patient appointments are scheduled by patients online annually. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, a secured site to access test results, to renew and refill prescriptions, and to perform other tasks including eVisits. More than 65,000 requests for test results and prescription renewals are received each year, and more than 3,000 eVisits have occurred since the pilot study in 2006. An eVisit offers patients easy access to health care by providing virtual clinical consultations for non-emergent conditions. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.


The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System has long worked to integrate web technologies into the delivery of health care to continually improve the quality, accessibility, and cost-effectiveness of care. In 2008, more than 80,000 patient appointments were scheduled by consumers on the System’s website. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, which has grown to become the largest eHealth portal in the Midwest with 237,000 patients enrolled.

MyHealth provides a private, secure site allowing patients to view customized health information, obtain laboratory and other test results, renew and refill prescriptions, manage billing issues, and participate in eVisits. More than 65,000 requests for test results and prescription renewals are received annually on MyHealth, and 3,000 eVisits have occurred since the pilot of this new service in 2006.

The eVisit offers convenient, cost-effective access to health care by providing virtual clinic consultations. eVisits may be used for non-emergent acute conditions such as stomach pain, and chronic conditions such as diabetes and hypertension. The eVisit begins when an enrolled patient logs into the MyHealth account and selects a non-urgent problem to report to the physician. A series of targeted questions survey the essential information, much as a physician would during a live office visit, and the patient’s responses are sent securely to the physician’s message center. The physician responds with a course of action or schedules an office appointment. eVisits are free of charge for Henry Ford Medical Group HAP members and $20 for other patients.

The eVisit improves patient access and allows physicians to make more frequent adjustments in a patient’s treatment regimen to achieve clinical goals. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.

eVisit patients surveyed had among the highest patient satisfaction scores of those using Henry Ford services:

  • 97% strongly agreed that their physician responded to them in a reasonable timeframe and were satisfied with the quality of the response.
  • 100% agreed they would use eVisit again and would recommend the service to others.
  • In a focus group conducted with insured patients aged 40 to 60 years, patients indicated they wanted even more online interaction with physicians in the future.

Physicians surveyed found the eVisit system easy to use, with 100% of respondents agreeing that:

  • The summation of the clinical patient interview provided adequate information to make clinical judgment.
  • They were satisfied with the quality of their interaction with their patient.
  • They would recommend the eVisit to their patients.

Chart reviews done to determine the clinical quality of eVisits showed that:

  • Patients were using the eVisit system appropriately, software worked appropriately, and physicians were answering appropriately.
  • Of 75 eVisit records reviewed, 86% qualified for a HEDIS measure, with these patients showing improved HEDIS measures compared to patients not using eVisits.

Through continually improving MyHealth services, Henry Ford remains at the forefront of transforming the quality of health care for all patients.

Keywords: access, care team, chronic care, Detroit, e-visits, Henry Ford Medical Center, health information technology, Michigan, MyHealth web portal, patient support, patient web portal, safety, treatment, value

For more information on this project, contact Pam Landis, IT Services, Henry Ford Health System, plandis1@hfhs.org.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel. 313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org