Michigan Value Collaborative: Improving post‑acute care after joint replacement

This is part of a series of articles on the successes of the Michigan Value Collaborative.

Achieving a goal can be daunting. But the Michigan Value Collaborative achieved its goal related to inpatient post-acute care rates following joint replacement surgery ahead of time.

In 2018, the Michigan Value Collaborative Coordinating Center set a goal of reducing the average inpatient post-acute care rate to less than 15% in at least 90% of MVC hospitals by 2020. (Inpatient post-acute care is defined as any skilled nursing facility or inpatient rehabilitation admission after index hospital discharge.) The goal was surpassed ahead of schedule: Inpatient post-acute care rates after joint replacement surgery dropped to a low of 10.8% in 2019.

To achieve its goal, the Coordinating Center:

Facilitated a regular virtual joint replacement workgroup that gives hospitals and physician organizations an opportunity to interact, collaborate and share best practices
Used collaborative-wide meetings, site visits, unblinded data sessions and hospital-level reports to assist with appropriately reducing the use of inpatient post-acute care

Across Michigan, MVC member hospitals also implemented their own targeted initiatives and tools specifically designed to reduce the unwarranted use of inpatient post-acute care after joint replacement surgery.

Background

Through the Blue Cross Blue Shield of Michigan Collaborative Quality Initiatives program, we learned that the quality outcomes for Michigan patients receiving post-acute care following joint replacement were no better than for those recuperating at home. MVC worked with our knee and hip replacement CQI to educate Michigan providers about this finding and help them reduce unnecessary utilization while keeping quality outcomes high.

The drop in the use of inpatient post-acute care after joint replacement surgery is a result of several initiatives by MVC member hospitals over the last few years. Below are two key programs.

Joint camps

These camps take place before surgery to provide patients with the necessary education about their procedure and offer a forum for patients to ask questions. If a patient has a concern, there’s an opportunity to address it and organize any additional support that’s required to meet their needs. These sessions are also used to reiterate the message of recovery at home, allowing participants to meet with physical therapists and learn post-op exercise regimens to aid recovery.

Joint educational resources

In an attempt to reduce readmissions and emergency department visits, a number of MVC member hospitals have developed educational materials to share with both patients and caregivers.

For example, Ascension Borgess, McLaren Flint, Spectrum Lakeland and Metro Health use the “Traffic Light System” to support patients after surgery. Refrigerator magnets are provided that divide symptoms into three categories: green (all clear), yellow (caution) and red (medical alert). For each category, the tool provides signs and symptoms to watch for and details specific instructions for managing these, including guidance on when to seek medical assistance — and who to call when medical assistance is needed. Each of these hospitals has also provided their patients with informational handouts, offering guidance on wound care and daily exercise routines.

MVC member hospitals also use technology to communicate with patients. In recent years, St. Joseph Mercy Ann Arbor has used “Twistle,” a personalized patient engagement and education app designed to help improve patient outcomes. Henry Ford Allegiance uses “Medbridge,” an innovative technological solution aimed at managing home exercise and continuing education out of the hospital.

Sharing data and best practices

To support this activity and further drive the improvement of follow-up rates after discharge, the MVC Coordinating Center facilitated opportunities for best practice sharing and provided benchmarked performance data to help inform internal improvement efforts.

In partnership with the Michigan Arthroplasty Collaborative Quality Improvement group, the Coordinating Center delivered regular joint workgroups aimed at helping improve patient outcomes after joint replacement. This provides an accessible online platform for hospital and physician organization leaders to come together and discuss various topics, including effective follow-up approaches, post-surgery pain management and joint replacement in outpatient settings.

The MVC Coordinating Center has also developed and distributed inpatient post-acute care push reports to help members identify areas of opportunity to reduce inpatient post-acute care use where appropriate. The first report was shared in February 2018 and a refresh was sent to members in early 2020.

To increase the usefulness of these reports, the Coordinating Center showed unblinded hospital performance data at its November 2018 and April 2019 collaborative-wide meeting. This allowed attendees to see their rates of inpatient post-acute care after joint replacement compared to their peers, identify hospitals that were doing well, and then contact those hospitals to learn best practices. Those hospitals performing well were also invited to offer insight as to how this had been achieved and what mechanisms other hospitals could adopt to improve performance levels.

While the initial target has been reached, the Coordinating Center will continue to support quality improvement efforts to reduce inpatient post-acute care rates after joint replacement surgery.

To learn more

To find out more about the Michigan Value Collaborative, check out their website and blog, or follow them on Twitter. If you’re interested in learning more about MVC or have any questions, you can reach the Coordinating Center at michiganvaluecollaborative@gmail.com.

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