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AHRQ’s Questions Are The Answer

Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction.

Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.

Click on the AHRQ banner above to visit the site.

Honoring Choices Massachusetts

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Who We Are Honoring Choices Massachusetts is a consumer focused, nonprofit organization which informs, empowers and helps adults make a health care plan and connect to quality care that honors their choices, all through their lives.

We provide access to comprehensive health care planning information, Massachusetts planning documents, and an easy to follow three step planning guide to help adults create their own personal health care plan.

We also help adults and families connect to Community Partners who provide hands-on help and resources to help adults start a health care planning discussion, create a personal plan and connect to person-centered care. Community Partners are community groups, care professionals, and health care organizations who work together to share resources and coordinate care for adults and families in their communities.

Our mission is to ensure that Massachusetts adults, including our most vulnerable citizens, have access to early and on-going health care planning that promotes wellness and lifelong person centered care that honors their values and choices.

Leveraging Data Reports Webinar Series – Recordings Now Available

The Center for Health Information and Analysis (CHIA), Massachusetts Health and Hospital Association, Massachusetts Coalition for the Prevention of Medical Errors, and New England QIN QIO have partnered up to offer a webinar series on leveraging data reports to drive quality Improvement.

CHIA’s and New England QIN-QIOs Readmission Reports Methodology is available here...

Our 1st Session focused on CHIA’s All-Payer Hospital Specific Report. We also highlighted how a Massachusetts hospital has utilized the QIO reports to drive their readmission improvement activities.

Download presentation slides here...
Watch the recorded webinar here...

Our 2nd Session focused on the NE QIN-QIO’s Medicare, Fee for Service Hospital Specific Report. We will also highlight how a Massachusetts hospital has utilized the QIO reports to drive their readmission improvement activities.

Download the presentation slides here...
Watch the recorded webinar here...

From Multiple Angles, Readmission Rate are Decreasing

A variety of different measures all point to one inescapable fact: readmissions of Medicare patients at Massachusetts hospitals are steadily decreasing, according to a new MHA analysis.

Statistics over the past decade show that Massachusetts hospitals, as well as hospitals nationwide, over the past decade at first had incremental improvements in readmissions before experiencing a significant drop beginning in 2012. The improvements may be due to the increased focus on the issue that hospitals undertook in response to Medicare readmission penalties that the federal government instituted in recent years.

The data shows that readmissions held steady for about seven years and then beginning in 2012, and continuing in 2013, readmissions declined distinctly. (The 2012-to-2013 decrease was slower than the 2011-to-2012 decrease, however.)

Another measure, which focuses on "all-cause" readmissions and not just those confined to heart attack, heart failure, and pneumonia patients, shows Massachusetts readmissions dropping 1.9% in 2013 versus 2012.

Yet another source of data - "Medicare 30-day unadjusted all cause readmission measures for fee-for-service beneficiaries of all ages" - was developed by CMS to help target geographic variation in care. MHA's analysis of this data showed Massachusetts readmission rates went from 8.1% above U.S. rates in 2008 to 2.3% above in 2013. Readmissions per 1,000 beneficiaries dropped for five consecutive years in both Massachusetts and the U.S., and at a continuously acclerating pace. Readmissions and readmissons per 1,000 beneficiaries dropped more than 20% from FFY 2007 to FFY 2013 in both Massachusetts and the U.S.

David Smith, MHA's Senior Director, Health Data Analysis & Research, says, "The decline in Medicare readmissions may have been caused by care improvements - such as better case management, improved care transitions, and coordinated care practices - that were incentivized by payment reforms such as the Medicare Readmission Reduction Program."

In 2013, MHA's Board of Trustees challenged all hospitals to reduce readmission rates by 20% over the next three years, and MHA has been leading the effort to bring providers together to share strategies of what works to reduce re-hospitalizations.

But lowering readmissions is not always easy. Patients move from one setting of care to another or to one set of care providers to another during an episode of illness. As patients and families navigate across new care settings and among different care providers, they often encounter communication challenges and confusion around who is clearly accountable for their care. This can lead to medical errors, duplication, increased costs and, sometimes, higher rates of re-hospitalization.

Scholarship has also demonstrated that hospitals serving socioeconomically disadvantaged populations incur more readmission penalties than other hospitals. Because poorer people may find it hard to fill prescriptions, adhere to complex post-hospital care regimens, and travel to outpatient clinics, their chances for readmissions increase. Reducing funding to hospitals that serve the poor creates a situation, according to recent studies, whereby access to care for the poor is reduced.

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

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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