Award to Study Hospital Discharge Process in Rural Montana
May 20, 2013
University of Montana researchers, in partnership with Missoula’s Providence St. Patrick Hospital, will use a new funding award to investigate how the hospital discharge process affects the treatment outcomes of patients from rural areas and to explore ways to improve those outcomes.
The $1.85 million award was presented through a highly competitive process by the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit organization authorized by Congress in 2010. PCORI funds research that provides patients, caregivers and clinicians with evidence-based information needed to make better health care decisions.
“This award will be used initially to understand the experiences people have when they discharge from St. Patrick Hospital to one of the more-rural counties in western Montana,” said Craig Ravesloot, director of Rural Health Research with the UM’s Rural Institute on Disabilities. “We worked with the hospitals in Plains, Polson, Deer Lodge and Dillon, which serve large rural counties. The partnership with those hospitals was key to the success of our proposal.”
The participating rural hospitals are Barrett Hospital and HealthCare in Dillon, Deer Lodge Medical Center in Deer Lodge, Clark Fork Valley Hospital in Plains and Providence St. Joseph Medical Center in Polson.
The researchers will investigate what patients from rural counties need for recovery following discharge from St. Patrick Hospital. Compared with Missoula, patients going home to rural areas typically have less access to needed services.
Dr. Joseph Knapp, a cardiologist with St. Patrick’s International Heart Institute, said they want to discover whether all patient needs are being met after they are discharged and if they might develop a new model for coordination between the Missoula hospital and the four critical access hospitals in the outlying communities.
“Fifty-three percent of St. Patrick Hospital’s patients come from outside Missoula County,” Knapp said. “When patients leave the hospital and go back home, we want to understand whether we are meeting their needs. Is their care transition seamless? Do they receive follow-up treatment? Is the care they receive what these folks want?”
The clinical data analysis portion of the research will be performed through the International Heart Institute Foundation because of its existing infrastructure, interest and expertise in the specific research of clinical outcomes and comparative effectiveness. Specific discharge subgroups will be the focus and likely will include orthopedics, pneumonia, stroke and heart failure patients.
“Together with our University colleagues and critical access partner hospitals, we seek to optimize the health care experience in western Montana,” Knapp said.
Tom Seekins, director of the Rural Institute’s Research Unit, said the project is part of a larger effort to ensure that patients get the treatment that has the greatest chance of achieving the outcomes they want.
“Studies have shown that the cost of re-hospitalization is one of the highest avoidable costs in medicine – one that medical providers, hospitals and insurers are trying to control,” Seekins said.
Researchers at Boston University demonstrated that a re-engineered discharge process improved patient care and reduced costs. Those researchers were careful to note, however, that their model worked well in a large city where the resources and people are close, but a different approach would be needed in rural areas.
“Say you have a hip replacement and the surgery goes well,” Seekins said. “But you are sent home without a plan that takes into account that you will need help caring for an elderly parent who lives with you, and something happens that sends you back to the hospital. That can be very expensive for everyone. But if you have a plan that takes such demands into account, you’re more likely to heal successfully.”
Ravesloot said the project is designed to develop and test an innovative discharge planning process. The first part of their research will involve talking to patients in the target communities to learn about their experiences and the degree to which their needs were met. Then, a design team – made up of representatives from the rural towns and hospitals, the Montana Hospital Association and Montana State University – will use the data to engineer a new rural model for testing.
“We will get the patient perspective on what’s important when you discharge back home,” Ravesloot said. “We want to design new components for discharge that are just as precise as any medical treatment.”
The study is one of 51 projects totaling $88.6 million approved for funding by PCORI’s Board of Governors on May 6. All were selected through a highly competitive review process in which scientists, patients, caregivers, and other stakeholders helped to evaluate more than 400 applications for funding. Proposals were evaluated based on scientific merit, how well they engage patients and other stakeholders, their methodological rigor and how well they fit within PCORI’s national research priorities.
The awards are part of PCORI’s second cycle of primary research funding. This new round of funding follows PCORI’s initial approval of $40.7 million in support for 25 projects under the institute’s national research priorities. All awards in this most recent round of funding were approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract. More information is available at http://www.pcori.org.
About The Patient-Centered Outcomes Research Institute (PCORI)
The Patient-Centered Outcomes Research Institute is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research to provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work.
Craig Ravesloot, direct¬¬or of Rural Health Research, UM Rural Institute, 406-243-2992, firstname.lastname@example.org; Dr. Joseph Knapp, International Heart Institute cardiologist, St. Patrick Hospital, 406-329-5615, email@example.com; Timothy Descamps, executive director, International Heart Institute Foundation, 406-329-2676, firstname.lastname@example.org.
Media Contacts at the Rural Hospitals are:
Deer Lodge – Tony Pfaff, CEO, Deer Lodge Medical Center, 406-846-7715, email@example.com.
Dillon – Maria Koslosky, quality service director, Barrett Hospital and HealthCare, 406-683-3190, firstname.lastname@example.org.
Plains – Russell Logan, assistant to the CEO, Clark Fork Valley Hospital, 406-826-4813, email@example.com.
Polson – Mary Moberly, director of nursing, Providence St. Joseph Medical Center, 406-883-8940, firstname.lastname@example.org.