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The Healthy Living Center of Excellence

Managing your health doesn't just happen in your doctor's office. You do it every day at home, at work, and with your family and friends. To help manage your health the Healthy Living Center of Excellence offers free self management education programs.

The free self-management education programs teach you skills that put you at the center of your care. Whether you have diabetes, arthritis, heart disease, chronic pain, or another serious health condition, these programs give you the tools to help manage your symptoms and overall health. During the programs you will learn from others who are like you, and make new friends to share what you learn when the program ends.

We believe that a collaborative partnership between activated older adults, their medical providers, and community-based organizations is the most effective model for managing the healthcare needs of an ever growing aging population.
The variety of programs offered will help adults maintain their independence, increase self-confidence and improve overall health.
The programs offer proven interventions addressing lifestyle and health conditions, such as:

Management of chronic illness;
Healthy eating;
Managing difficult emotions/depression;
Importance of physical activity;
Fall prevention management; and
Socialization.

Our Programs:

We have a range of programs promoting health and wellness! Our programs include:

Chronic Disease Self-Management
Diabetes Self-Management
Spanish Chronic Disease Self-Management
Spanish Diabetes Self-Management
Chronic Pain Self-Management
Cancer: Thriving and Surviving Program
Positive Self Management for HIV
Better Choices, Better Health
A Matter of Balance
Tai Chi for Healthy Aging
Tai Chi for Arthritis
Healthy Eating for Successful Living
Powerful Tools for Caregivers
Healthy IDEAS
Enhance Wellness

Visit our website for a description of each program, to access the statewide workshop calendar or to make a referral. You can also call 978-946-1211 for more information or to register for a workshop.

Brigham’s DASH Initiative Reduces Readmissions

The percentage of patients admitted to a hospital with a mental health condition - either as a primary or a secondary diagnosis - is rising and often these patients experience delirium, alcohol withdrawal and suicide harm (DASH), which put them at an increased risk for higher-than-average readmission rates.

In a new report in the July 2015 edition of The Joint Commission Journal on Quality and Patient Safety, clinicians at Brigham and Women's Hospital (BWH) describe the implementation and effectiveness of a hospital-wide clinical improvement initiative for acute care patients at risk for DASH and demonstrate its effectiveness in reducing readmission rates.

The population-based effort implemented across all departments at BWH enhanced screenings for DASH. These screenings were accompanied by the adoption of new care management guidelines to effectively address patients who were identified as being at risk for these conditions.

"Patients with a DASH diagnosis can be found anywhere in the hospital, so it was important to include our entire patient population in our efforts," said Barbara E. Lakatos, DNP, PCNS-BC, APN, program director of the Psychiatric Nursing Resource Service at BWH and the lead author of the paper. "If not appropriately identified and treated, delirium can lead to negative outcomes and poor quality of life for those affected."

The care improvement process consisted of the development of guidelines; implementation/rollout; integration into practice; and ongoing practice development and evaluation. In 2009, an interprofessional task force comprised of hospital leadership, physicians, nurses, and other healthcare professionals conducted a literature review to identify existing evidence-based assessment tools focused on DASH symptoms and also reviewed existing hospital policies and best practices to guide the new hospital-wide program.

After screening and care guidelines were developed, Lakatos and her colleagues embarked on a hospital-wide effort to integrate them into the clinical workflow in 2010. Training videos, resource manuals and role-playing workshops were developed and assessment tools were embedded into nursing and medical workflows in stages, starting with pilot units and later being adopted across the entire hospital.

"Whenever a patient was identified as high risk for DASH, we convened an interdisciplinary care team for a discussion about the best approach for that patient," said Adam C. Schaffer, MD, hospitalist at Brigham and Women's/Faulkner Hospitals and co-author of the report. "Although we established guidelines, the approach for each patient was personalized and directed by the collaborative care team with consideration of the patients' individual health history and symptoms."

An assessment of the DASH population at BWH was conducted pre- and post-program implementation (from FY 2010 to FY 2013) to measure its effect. All inpatients were included with the exception of neonatal and hospice patients. This assessment showed the volume, average length of stay, clinical service line, discharge location and 30-day admission rate of DASH patients. Lakatos and her colleagues found that while the DASH population increased by one percent from 2012 to 2013, the 30-day readmission rate decreased by nine percent from 2010 to 2013.

David Gitlin, MD, chief of the division of medical psychiatry at Brigham and Women's/Faulkner Hospitals and co-author of the paper, said, "A key reason for these positive results is that our DASH program was embedded in the clinical culture at the Brigham. Successful implementation and sustainability in other organizations will similarly require aligning with processes and resources already in place."

Cambridge Health/Hallmark Health Reduce Readmissions

Cambridge Health Alliance (CHA) and Hallmark Health, in collaboration with Somerville Cambridge Elder Services and Mystic Valley Elder Services, are among the top performers in an innovative national pilot program to reduce hospital readmission rates.

The four organizations, known collectively as the Mystic Valley Community-Based Organization, joined 71 other community-based organizations (CBOs) across the U.S. in the Centers for Medicare & Medicaid Services (CMS Community Care Transitions Project (CCTP) in 2012.

According to early findings by the CCTP, the Mystic Valley group reduced 30-day readmission rates in certain high-risk patient populations by nearly nine percent over a two-year period, ranking among the best improvements nationally.

The CHA component of the project, known as the Hospital-to-Home Program, includes both CHA’s Cambridge and Whidden Hospitals. At both hospitals, transition facilitators meet with patients before discharge to learn about their healthcare needs and assess their home care requirements. This is followed up with home visits from a transition facilitator or a nurse practitioner within 48 hours of discharge. Ongoing phone calls allow the team to further monitor patients’ health. Hallmark Health uses a similar “health coach”/transition facilitator model, and sends hospital nurse practitioners to visit with newly discharged patients in the home or other care settings, such as a nursing home or rehabilitation facility. Nurse practitioners can write prescriptions and adjust medications and treatment plans in collaboration with the patients’ primary care providers.

“Between the transition facilitators and the nurse practitioners we are able to identify indicators that could eventually lead to a readmission and take immediate corrective action,” said Cheryl Warren, MS, RN, chief clinical integration officer at Hallmark Health. “The new teams can assess social and physical triggers and make adjustments to medications and treatments in real time in the patients’ home or care facility, keeping patients home, healthy and well cared for.”

“We have learned that providing excellent health care necessitates supporting our patients in their homes and community,” said Rich Balaban, MD, medical director of CHA’s Hospital-to-Home Program. “Our partners have enabled us to extend our reach so that together, we now provide a broad range of community-based medical and home care services. We are proud of the progress we have made and the many lives we have improved.”

Job Opportunities

Job Seekers:

Find your next Massachusetts hospital or health care job on MAHospitalCareers.com! Sponsored by the Massachusetts Hospital Association, MAHospitalCareers.com helps you locate jobs in nursing, physical therapy, radiology, orthopedics and much more. Search for health care jobs, register for free emailed job alerts, research Massachusetts hospitals and learn about Massachusetts healthcare licensing and regulations. Best of all, everything is free for all health care professionals!

Massachusetts Hospitals:

Are you looking for qualified health care professionals for your Massachusetts hospital? MAHospitalCareers.com can help. As a service of Massachusetts Hospital Association, MAHospitalCareers.com connects thousands of nurses, doctors and other hospital job seekers with Massachusetts hospitals each year.

Choosing Wisely

Massachusetts Health Quality Partners (MHQP) Launched the Choosing Wisely Massachusetts Website

Choosing wisely® aims to promote conversations between providers and patients by helping patients choose care that is:

- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary

Recognizing that patients need better information about what care they truly need in order to have these conversations with their providers, patient-friendly materials have been developed and many consumer groups are working on disseminating them widely.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is an appropriate and necessary treatment. As each patient situation is unique, providers and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

Choosing Wisely Massachusetts Website

Massachusetts Health Quality Partners is leading a multi-stakeholder effort to advance the ABIM Foundation's Choosing Wisely® campaign in the Commonwealth. The goal of this effort is to encourage physicians and patients to discuss medical tests and procedures that may be unnecessary, and in some instances cause harm. Reducing unnecessary medical care can improve quality for Massachusetts patients.

The Choosing Wisely Massachusetts Campaign Will:

- - - - Build broad public awareness and interest in Choosing Wisely in Massachusetts.
        
        Engage providers to integrate Choosing Wisely recommendations and materials in their practice.
        
        Engage patients and families to use Choosing Wisely consumer materials to become better informed about the decisions and choices they need to make about their health and health care.
        
        Identify ways to engage providers and patients to better communicate using Choosing Wisely materials.

ASK YOUR DOCTOR IF THAT IMAGING TEST IS NECESSARY

Healthcare interests across the state have come together to encourage patients to discuss with their physicians whether diagnostic imaging in the treatment of lower back pain and persistent headaches is appropriate. The local effort includes more than 20 organizations participating in Choosing Wisely Massachusetts and is being led by Massachusetts Health Quality Partners (MHQP), of which MHA is a member.

By examining 2013 clinical quality data, MHQP found that about 20% of the imaging tests that the state's primary care physician practices ordered for lower back pain are not indicated. The American College of Radiology points out that most people who seek medical help for headaches have migraines or tension-type headaches, and that all that is usually needed for doctors to diagnose them is a careful medical history and a neurological exam. Adding a CT scan or MRI rarely shows why a headache occurs and it does nothing to ease the pain.

Participating organizations and agencies will be disseminating Choosing Wisely information to their constituents - providers, patients, and consumer groups - throughout the month to raise awareness and interest in the campaign. MHQP has been leading the Choosing Wisely Massachusetts Campaign for two years with support from the Robert Wood Johnson Foundation and the ABIM Foundation; ABIM is behind the national Choosing Wisely Campaign, in which various medical specialties drew up lists of evidence-based recommendations that patients can use in their discussions with their doctors.

"People suffering from lower back pain or frequent headaches want to know what's going on and they want relief," said Steven Defossez, M.D., MHA's V.P. of Clinical Integration and a practicing radiologist and MRI specialist. "Cross-sectional imaging tests are powerful tools, which when applied thoughtfully can result in accurate diagnoses and appropriate care plan formation. Therefore it's not surprising that patients often look to an MRI or CT scan for answers. However, diagnostic imaging may not always be the best option. Over-utilization of diagnostic imaging is wasteful at best and may actually be harmful. It's important for patients to work collaboratively with their caregivers, following evidence-based best practices, to get the best outcome."

Massachusetts Health Quality Partners (MHQP)

As the statewide regional health improvement collaborative in Massachusetts, Massachusetts Health Quality Partners (MHQP) is uniquely positioned to leverage and connect its existing initiatives and partnerships - including its strong multi-stakeholder governance structure of actively engaged physician, health plan and patient/public councils - to introduce and promote the Choosing Wisely® campaign in Massachusetts.

As part of their work, MHQP convenes an Advisory Group every quarter to help guide the development and implementation of a localized, collective version of the Choosing Wisely campaign focused on the following recommendations:

- - - - Imaging for lower back pain
        
        Imaging for uncomplicated headache
        
        Early induction in childbirth
        
        Colorectal cancer screening

Antibiotic overuse for:

- - - - Pediatric URI
        
        Adult sinusitis
        
        Urinary tract infections
        
        Cancer treatment at end of life

MHQP has also launched the Choosing Wisely Massachusetts Website and conducted awareness activities via its social media outlets and a statewide radio PSA. MHQP has begun to recruit "Choosing Wisely champions" from local specialty societies, such as the Massachusetts Radiological Society and Massachusetts Medical Society's Committee on Interspecialty, as well as to support local uptake of the campaign and materials by individual organizations including health plans, employers and provider organizations. MHQP's future plans include rolling out campaign materials in spring 2014, starting with recommendations around imaging for lower back pain. MHQP will also support the continuing work of its partners to integrate Choosing Wisely within their respective institutions and organizations. Massachusetts Health Quality Partners is a nonprofit coalition of health care providers, health plans, employers, patients, academics and government agencies working together to promote improvement in the quality of health care services in Massachusetts. MHQP's mission is to drive measurable improvements in health care quality, patients' experiences of care, and use of resources in Massachusetts through patient and public engagement and broad-based collaboration among health care stakeholders.

Nursing Initiatives

NursingMA-Action-Coalition(1)

In 2010, the Institute of Medicine (IOM) issued a landmark report and evidence-based recommendations on the important role nursing will play in our nation's health care transformation.
To meet growing health care demands and challenges and to serve patients better, we need to change how nurses are educated, trained, and practice.
The Massachusetts Action Coalition is one of 51 coalitions working nationwide to advance nursing to meet current and future health care. Our goals are to:

increase the percentage of Massachusetts nurses with baccalaureate and higher degrees who can manage increasingly complex patients and health system challenges in all practice settings;
strengthen education and training so nurses in Massachusetts can meet the growing needs of an aging and ethnically diverse patient population;
improve access to higher levels of nursing education by facilitating transfer of credits between degree programs and ensuring there is sufficient nursing faculty in our schools;
eliminate outdated regulatory barriers and organizational policies that limit nurses from practicing to the full extent of their education and training;
improve data collection and analysis to better understand nursing workforce supply and demand

Improvement Resources

The websites below offer information about organizations and programs to improve the quality and safety of healthcare services in Massachusetts and beyond.

Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization helping to lead the improvement of healthcare throughout the world. IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping healthcare systems put those ideas into action.

Massachusetts Coalition for the Prevention of Medical Errors is a public-private partnership whose mission is to improve patient safety and eliminate medical errors in Massachusetts. The Coalition’s membership includes consumer organizations, state agencies, hospitals, professional associations for physicians, nurses, pharmacists, long-term care workers, as well as health plans, employers, policymakers, and researchers. The Coalition leverages the efforts of all of these organizations to accomplish the shared goal of improving patient safety. The Coalition promotes a systems-oriented approach to improving patient safety, identifying the causes of medical errors, and developing and supporting implementation of strategies for prevention.

The Betsy Lehman Center for Patient Safety works with providers, patients and policymakers to advance the safety and quality of health care. Visit its website for actionable toolkits and other resources for health care providers, and sign up for its monthly email newsletter for updates on local patient safety news and research. The Center is also building a network of peer support programs to help those affected by a medical error or adverse event.

U.S. Agency for Healthcare Research and Quality’s (AHRQ) website includes access to clinical information, research findings, consumer/patient healthcare information, quality and patient safety information, data and surveys.

WhyNotTheBest was created and is maintained by the Commonwealth Fund, a private foundation working toward a high performance U.S. health system. It is a free resource for healthcare professionals interested in tracking performance on various measures of healthcare quality. The site enables organizations to compare their performance against that of peer organizations, against a range of benchmarks, and over time. Case studies and improvement tools spotlight successful improvement strategies of the nation’s top performers.

Ventilator Associated Event (VAE)

VAE Summary:

Mechanically ventilated patients are at high risk for complications. These risks include VAE, peptic ulcer disease (PUD), gastrointestinal bleeding, aspiration, venous thromboembolic events (VTE), and problems with secretion management. Evidence-based interventions can reduce the risk of these complications and reduce the occurrence of VAE. Implementing the ventilator bundle has shown to reduce VAE. The VAE prevention bundle includes: head of bed elevated 30 to 45 degrees, oral care with chlorhexidine 0.12%, peptic ulcer prophylaxis, deep vein thrombosis prophylaxis, and spontaneous waking trials and spontaneous breathing trials.

VAE 2017 Top Ten, Evidenced Based Interventions

HRET’s 2018 VAE Change Package

Eliminate Harm Across the Board HRET’s Days Since Last VAE

AHRQ’s Effective Health Care Program

AHRQ's funds individual researchers, research centers, and academic organizations to work together with the Agency for Healthcare Research and Quality (AHRQ) to produce effectiveness and comparative effectiveness research for clinicians, consumers, and policymakers. AHRQ is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making.

The Effective Health Care Program:

Reviews and synthesizes published and unpublished scientific evidence.
Generates new scientific evidence and analytic tools.
Compiles research findings that are synthesized and/or generated and translates them into useful formats for various audiences.

The Effective Health Care Program produces three primary products:

Research reviews: These comprehensive reports draw on completed scientific studies to make head-to-head comparisons of different health care interventions. They also show where more research is needed.
Original research reports: These reports are based on clinical research and studies that use health-care databases and other scientific resources and approaches to explore practical questions about the effectiveness - or benefits and harms - of treatments.
Summary guides: These short, plain-language guides - tailored to clinicians, consumers, or policymakers - summarize the findings of research reviews on the benefits and harms of different treatment options. Consumer guides provide useful background information on health conditions. Clinician and policymaker guides rate the strength of evidence behind a report's conclusions. The guides on medications also contain basic wholesale price information.

For further information, please follow one of the following links:

The Effective Health Care Program
Research Summaries for Consumers, Clinicians, and Policymakers
Tools and Resources
Search for Guides, Reviews, and Reports
Research Available for Comment
Submit a Suggestion for Research
Submit Scientific Information Packets
Comparative Effectiveness Research Grant and ARRA Awards
News and Announcements
What Is Comparative Effectiveness Research
Who Is Involved in the Effective Health Care Program

AHRQ Offers New Version of its Quality Indicators™ Toolkit

A new version of the AHRQ Quality Indicators™ Toolkit for Hospitals (QI Toolkit) is available to help acute care facilities improve inpatient quality performance.

Using this free QI Toolkit offers hospitals the opportunity to:

Improve performance on two sets of AHRQ Quality Indicators, 18 Patient-Safety Indicators (PSIs) and 28 Inpatient Quality Indicators (IQIs).
Measures hospital quality using available inpatient data to assess the quality of care, identify areas that need improvement, and track performance over time.
Approach quality improvement work from various levels of readiness. Facilities can select any of the 33 tools available to meet their specific hospital quality needs. The tools are designed for multiple audiences, including senior leaders, analysts, and multidisciplinary improvement teams.
Take advantage of "Best Practices" for 14 PSIs, including information to determine where gaps exist and suggestions for hospitals regarding improvement, process steps, and additional resources.

Author: admin