Increasing Quality Care through University of Utah Health Partnership
Since our founding in 1928, Community Nursing Services (CNS) has always cared for University of Utah patients transitioning home from hospital care. We are proud of our shared goals for exceptional patient care and outcomes and have long partnered with the University of Utah Health system to care for our community. We are thrilled to announce that in April 2020, our public-private partnership became official after a rigorous state bid process and legal review. This formal affiliation has already shown benefits to patients who require Home Health or Hospice care. The partnership has and will continue to increase collaboration, mutual support, and patient referrals to CNS while also allowing each organization to continue to operate autonomously.
Both organizations maintain high standards of patient accessibility and care, and these shared values helped create a seamless transition into the partnership. Brent Jones, President of CNS shares, “The mission statements of both our organizations are well-aligned and we have a long history of working together to create a positive experience for our patients. As patients move from hospital to home through our multiple home-based service lines, they’ll experience enhanced quality-of-care and better communication and coordination at transition points.”
The partnership is mutually beneficial, as the collaboration allows both organizations to enhance the care they already expertly provide which enhances patients’ experience and outcomes. “Through this partnership, we are now able to offer our patients a seamless continuity of care,” says Gordon Crabtree, CEO of University of Utah Health Hospitals and Clinics. “Patients in need of home-based or Hospice care will now benefit from even greater coordination which means better outcomes and a higher degree of satisfaction from patients and their families facing difficult health challenges.”
With this partnership, CNS has also strengthened the collaboration among the leadership of both organizations. CNS welcomed three University of Utah leaders to the CNS Board of Trustees: Tracy Nixon, CNO, MSN, RN; Charlton Park, CFO, CAO; and Dr. Peter Weir, U of U Health system’s Executive Medical Director of Population Health.
Collaborating through COVID-19
As CNS and the University of Utah Health were going through the affiliation process in early 2020, COVID-19 was simultaneously taking its hold on the community. One of the first collaborative efforts that came out of the partnership is a program called Heal at Home, modeled after Huntsman at Home. Through this program, U of U Health patients who receive elective surgery can now transition to CNS’s care while they recover at home or in the hospital’s patient and family housing facility.
The arising challenges during the pandemic sparked an idea in U of U Health orthopedic physician, Dr. Christopher Pelt. Around this same time, he happened to be treating Brent Jones, the President of CNS, and during one of his appointments Dr. Pelt brought up the idea. He shared concern about how they were having to cancel surgeries for patients who didn’t live locally due to the pandemic and restrictions on overnight hospital stays. He further shared that while many of these patients don’t need care in a hospital setting post-surgery, they aren’t well enough to jump in a car and drive several hours. Dr. Pelt let Brent know he’d like to try sending these total-knee or hip replacement patients to the patient and family housing the same day. The patients could come in at 8:00 a.m., get surgery, and leave by 3:00 p.m. When they got to their housing, a nurse could visit the same evening and the next morning, followed by a physical therapist.
The idea started there, and as CNS and U of U Health continued to collaborate, they asked themselves: “Why not provide this for local patients? Why not expand beyond orthopedic surgeries? Why not vascular? Neurosurgery? General surgery?”
Since its inception, the program has grown in scope and scale. While many of CNS’s team members work to facilitate the program, CNS ’s Regional Program Manager, Russell Hanson, actively manages the patient transitions for Heal at Home and meets with the clinical and administrative teams from the physicians’ offices to report the outcomes.
Increasing Quality of Care
Heal at Home has allowed patients to receive a safer and higher quality of care while they’re recovering from surgery. Russell Hanson points out, “It’s actually safer to be outside of the hospital environment. There are so many risk factors in the hospital setting; for example, you have higher risk for infection and for falls and that’s why being in the home is a better place to be.”
According to the Center for Disease Control and Prevention (CDC), “Each year, about 1 in 25 US hospital patients is diagnosed with at least one infection related to hospital care alone; additional infections occur in other healthcare settings. Many healthcare associated infections are caused by the most urgent and serious antibiotic-resistant (AR) bacteria and may lead to sepsis or death.”
Mental health plays a prominent role in recovery speed and outcomes as well. Kimberly Dansie, CNS VP of Business Development said, “We can’t forget the impact this program has on mental health. We feel better in our own home environment. We feel safer.”
The program’s impact on care ripples beyond the surgery patients it serves. By freeing up hospital beds, it increases capacity levels, allowing for other patients to receive care more quickly instead of waiting in observation or the ER.
Lowering Costs
Along with these program benefits, Heal at Home also increases affordability and accessibility through significantly lowered costs. Russell Hanson poses, “Where’s the least expensive place for a patient to be? In their home. It lowers the cost of post-surgery care–and we’re talking about a 50–60% reduction in cost.”
When CNS and U of U Health lower their costs, these services become more affordable for patients and increase overall accessibility. Kimberly Dansie explains, “With our shared missions of service to the community, we can help more patients in need. The University of Utah Hospital has a higher proportion of unfunded or underfunded patients than other hospitals. And we’re the same way with our mission of caring for people regardless of their ability to pay. So, through this collaboration we’re able to help more people.”
Partnering for Success
Russell Hanson points out how important it’s been for both organizations to work together: “One of the biggest benefits of this partnership is the collaboration and care. You have care being designed by both parties telling each other what they need and what they want. A lot of collaborations are made from a one-way street with a doctor mandating what they want. In working with U of U Health, our partnership is a two-way street. In fact, CNS starts building the recommended protocol and then takes it to the physician as they continue to work in partnership.
He continues, “These programs, again, are designed to lower the overall cost for the patient while increasing the outcome. And that’s why it’s been so important for the protocols that are designed by the physician team to be collaborative. The doctors and nurse practitioners from both organizations work together to decide what the home visits should look like and what requirements should be in place for the nurse or physical therapist when providing post-surgery care. We now have multiple collaborative protocols in place.”
Experiencing Similar Results Across the Board
Heal at Home isn’t the only collaborative program that has helped increase the quality of care while simultaneously lowering cost. CNS and U of U Health have partnered with the U of U Health Outpatient Clinic (IOC) to do just that, but through completely different means.
Dr. Peter Weir, CNS board member and U of U Health Executive Medical Director of Population Health, started the IOC as a pilot project in 2017. He asked the U of U Health to fund it with $500,000 for a year to prove its impact. He wanted them to find their 15 most expensive patients, which could include people who have chronic and complicated physical or mental health conditions or who frequently visit the ER for non-emergency care. He wanted to start with a small group so he could focus on learning more about their conditions and the entire scope of what factors created and continued to contribute to them.
During the first year, he learned that every single person in the pilot project had a high Adverse Childhood Experiences (ACE) score. “Adverse childhood experiences” refers to traumatic events such as experiencing or witnessing violence, abuse, or neglect. As ACE’s proven studies have shown, people who have a higher score have a significantly higher risk for physical and mental health problems later in life. For example, the Center for Disease Control and Prevention (CDC), cites that those with an ACE score of four or more have an increased risk of chronic pulmonary lung disease by 390%, hepatitis by 240%, and depression by 460%.
Learning about the patients’ backgrounds led Dr. Weir and his team to increase their focus on social work and mental health to help treat their patients’ underlying trauma. In expanding their care to more completely accommodate their complex and layered needs, the project reduced these patients’ medical costs by approximately 50% in the first year.
Peter credits much of the program’s success to the team, including Dr. Stacey Bank who runs the clinic out of CNS’s West Valley City office with a team of eight medical providers. They currently provide wrap-around care and support to 116 patients. Patients have weekly appointments with the IOC to help ensure they receive the highest level of care and stability, alternating between in-office and at-home visits with a CNS nurse. We’re proud to collaborate on these programs that significantly increase the quality of care patients receive and also lower the cost of care.
Our collaborative history with U of U Health and our more recent partnered programs and services only mark the beginning. With our official partnership in place, we look forward to strengthening the programs we have and creating more as our organizations collectively strive to provide the best possible care.