This post was authored by Joy A. Pollard, PhD, RN, ACNP-BC, Southeast Michigan “See You in 7” Hospital Collaborative planning committee member.

With heart failure readmissions for Medicare patients in southeast Michigan surpassing the national average of 24.4 percent in 2010, the ACC’s Michigan Chapter decided to take the problem head on by joining together with other local organizations to form the  Southeast Michigan “See You in 7” Hospital Collaborative. The goal: increase the number of follow-up appointments scheduled within seven days of discharge by implementing lessons learned from ACC’s Hospital to Home (H2H) early follow-up challenge, “See You in 7.” 

Serving on the planning team for the Southeast Michigan “See You in 7” gave me the opportunity to see first-hand how hospitals, quality improvement organizations, and other health care groups can work together and make a true impact on reducing readmissions on the local level.  The goal of the year-long collaborative was to create a vehicle for candid sharing of individualized strategies, successes and barriers, to reduce 30-day heart failure (HF) readmissions. Members chose process measures from the H2H “See You in 7” toolkit.  Five key features helped the collaborative meet their goal:

1. The right people at the table to tackle the problem
2. A framework that facilitated creating  action plans that could be measured
3. Inside and outside experts to share the latest innovations and to think about how to tackle reducing HF readmissions
4. Quarterly feedback to track progress and reappraise the need for a change of direction
5. The formation of a collegial bond between participants in order to express and share during the collaborative

Many groups of dedicated people made this project a success. Collaborative participants included CCAs and FACCs on the ACC Michigan planning committee who contributed to hospital recruitment and provided multidisciplinary conceptualization of the project.  The Greater Detroit Area Health Council provided executive leadership, meeting space and electronic communication and webinar support by virtue of a Robert Woods Johnson Foundation grant. The ACC H2H team provided the “See You in 7” framework.  MPRO, Michigan’s Quality Improvement Organization, provided hospital data on follow-up within seven days and 30-day readmission rates. But in my reflection, the collaborative success rests squarely with the teams from the 12 participating hospitals.

Member hospitals, although varying in size and location (urban and suburban) and range of  resources available via their individual HF programs, created an atmosphere of sharing  informative feedback about best care and utilization resources to innovate and surmount readmission barriers.

After a year of collaboration and implementation, did readmission numbers budge? Preliminary findings show hospitals that participated in the collaborative reduced 30-day HF readmissions by 10 percent, while hospitals across the state averaged 7.2 percent reduction during the same time period. These findings are encouraging and pave the way for other readmissions projects in other communities. We’re looking forward to seeing the complete results in the fall.

I hope you found my reflections on our collaborative inspiring and helpful. It is truly amazing what we can accomplish when we work together with a common goal. Watch for future blogs from our collaborative hospital team members as they share member insights from their “See You in 7” experiences too.

 

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