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Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home
Discharge to Assess (D2A) (also referred to as "flipped discharge") is a redesign of the care process at Sheffield Teaching Hospitals in the UK that involves assessing a patient’s needs after discharge in the patient’s own home rather than in the hospital. Activities that traditionally happen at the end of a hospital admission are instead performed successfully and safely at home, thus enabling patients who are medically ready to go home earlier and spend less time in the acute care setting.
10 IHI Innovations to Improve Health and Health Care
This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.
Achieving Hospital-wide Patient Flow
This white paper guides health care leaders and quality improvement teams through an in-depth examination of a system-wide view of patient flow within (and outside) the hospital, including high-leverage strategies and interventions to achieve hospital-wide patient flow.
A Simple Way to Involve Frontline Clinicians in Managing Costs
This article describes the building blocks of a value-management system in health care. The approach that IHI co-developed includes a simplified method to understand quality, cost, and workforce capacity on a weekly basis; a visual management system to present and analyze this data regularly; and daily, point-of-care communication to support continuous improvement.
Personalized Perfect Care
The authors propose measuring quality from the patient’s perspective as an expression of his or her personalized health needs. The Personalized Perfect Care Bundle combines several distinct measures into one and is scored as “all-or-none,” with the patient’s care being counted as complete if he or she has met all of the quality measures for which he or she is eligible.
What If We Flipped the Patient Discharge Process?
At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.
WIHI: The Right Care, Right Setting, and Right Time of Hospital Flow
March 9, 2017 | Making sure patients get the right care, in the right place, at the right time requires a number of underlying system improvements, including well-designed hospital flow.
Avoiding Overuse: The Next Quality Frontier
In this editorial, IHI President Emeritus Don Berwick makes the case that quality of care — that is, better matching care to needs, and practice to science — is central to addressing underuse of effective care and overuse of ineffective care. The editorial accompanies the "Right Care" series of articles that explores medical underuse and overuse worldwide.
WIHI: Improving the Rate of Recommended Care: Looking Back and Looking Ahead
January 12, 2017 | A study published in 2003 reported that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. Has the situation improved? Not nearly enough.
New Payment Models Drive Value
Standardizing processes, enhancing efficiency of care delivery systems, and optimizing capacity across care delivery systems are all essential in driving value and preparing care teams for managing patients in a bundled payment program.
This Coalition of 20 Companies Thinks It Can Change US Health Care
Based on IHI’s learning from work with employers to improve health care, this article offers five strategies to help employers — like those in the recently formed Health Transformation Alliance — achieve better care and better health for their employees, while also lowering costs (the Triple Aim).
Applying Radical Redesign Efforts
MemorialCare Health System's (California) strategy to provide high-quality care, reduce waste, and keep costs in line demonstrates three of the ten “New Rules for Radical Redesign in Health Care” developed by IHI Leadership Alliance members: standardize what makes sense; make it easy; and return the money.
WIHI: Getting Right Care, Right!
October 1, 2015 | There’s growing awareness of the need to curb health care’s overuse of interventions that lack a strong evidence base, unnecessarily subject patients to potential harm, and are more expensive than equally effective, cheaper alternatives.
Medicare at 50: Reflections from Former CMS Administrator Donald M. Berwick
IHI President Emeritus Don Berwick comments on the 50th anniversary of the US Medicare program, including the shift to payment based on the quality of care provided to patients, and the role of accountable care organizations (ACOs) in improving quality of care and reducing costs.
The Employer-Led Health Care Revolution
Intel is using Lean improvement methods to manage the quality and cost of its health care suppliers in Portland, OR. Their Healthcare Marketplace Collaborative model holds potential for employers, with their large purchasing power, to take the lead in securing better health for local populations and lowering costs for employees and companies alike.
WIHI: Bundles and Buy-In for Value-Based Care
March 12, 2015 | There’s no question that public and private payers in the US are moving towards more global payment arrangements with health care providers. But the picture of how health care delivery systems take up the challenge is still coming into focus.
WIHI: The Ups and Downs of Health Care Costs and Reform
February 12, 2015 | Against the backdrop of the Affordable Care Act and other significant US initiatives, this WIHI touches on recent progress with efforts to achieve better care and lower costs, global payments and various payer-led financial efforts designed to improve health care delivery, statewide reforms, Medicaid expansion, and more.
Patient-reported measures help clinicians and patients assess whether a patient’s symptoms, lifestyle, daily activities and functional status have improved as a result of care provided, and are a mechanism for patients to have a voice in their treatment planning and decision making based on their own self-assessments.
WIHI: Better Care and Better Value for Hip and Knee Replacement
October 23, 2014 | The frequency of a surgical hip and knee replacement that has comparatively low rates of harm and complications brings new scrutiny of performance and opportunities for improvement.
Health Care, the Whole Person, and Community Engagement: Church Health Center of Memphis, Tennessee
The Church Health Center in Memphis, Tennessee, is committed to encouraging healthy living for individuals as well as communities. Their work provides an inspiring example of a community that is working toward achieving the Triple Aim.
Enhancing Prehospital Emergency Care
This article makes the case that earlier prehospital interventions can positively affect downstream hospital patient outcomes and costs of care, describes how emergency medical services (EMS) are increasingly becoming part of an integrated care system, and discusses the expanded role of ambulance services and paramedics to increase access to care.
WIHI: Preventing Financial Harm to Patients: The Costs of Care Initiative
August 21, 2014 | On this WIHI, learn about an innovative effort in the US to help caregivers make more high-value decisions that can protect patients from unnecessary care and expenses.
WIHI: From Prehospital to In-Hospital: The Continuum for Time-Sensitive Care
July 24, 2014 | In this WIHI, we discuss the dramatic changes underway with emergency medical services (EMS) in both the US and globally.
Lessons Learned from Two "Super-Utilizers"
After implementing several interventions, including building capacity for primary care teams to customize patient care plans, this team decreased total annual charges from $600,000 to $3,000 for two patients considered to be "super-utilizers."
ACOs: A Step in the Right Direction
Accountable care organizations (ACOs) can be a step forward in the journey toward aligning payment and delivery mechanisms to achieve better care and better health at lower costs. This article includes recommendations that may serve to accelerate our collective efforts toward achieving cost- and quality-related improvements at scale.