Is Punam Keller’s heart failure education pilot something we can generalize and make sustainable? Many institutions may not have the resources to add the recommended 10 minutes or more to a discharge session. Would financial incentives need to change beyond the 30-day readmission rule?
If the process could be automatic and seamless, with no service provider’s time increased as a result of the intervention, Keller says “go for it.” Also important is active choice — the patient’s decision to act or not act on recommendations following discharge. But, says Keller, “sometimes you can’t do those two things, and you have to come up with plan C.”
Keller’s heart failure education team could have simply noted potential barriers to compliance in the discharge package, along with solutions to those barriers, and sent patients on their way. But they enjoyed engaging patients in conversation and felt that during those 10 minutes “they were co-producing the solution with them.” There is also value in the team member talking to the cardiologist after discharge and putting those notes in the patient’s file for follow-up appointments. “Now you’ve got a chance for the cardiologist or the primary care physician to have a conversation with the patient about either how well they’re implementing a particular challenge they were facing or another challenge they may have faced as a result of that,” says Keller. “You can think about [the extra 10 minutes] as a cost to the system, but really what I’m focused on is the cost to the patient.”
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.