Rapid reengineering of acute medical care for Medicare beneficiaries: the Medicare innovations collaborative.

In 2009 we described a geriatric service line or "portfolio" model of acute care-based models to improve care and reduce costs for high-cost Medicare beneficiaries with multiple chronic conditions. In this article we report the early results of the Medicare Innovations Collaborative, a collaborative program of technical assistance and peer-to-peer exchange to promote the simultaneous adoption of multiple complex care models by hospitals and health systems. We found that organizations did in fact adopt and implement multiple complex care models simultaneously; that these care models were appropriately integrated and adapted so as to enhance their adoptability within the hospital or health care system; and that these processes occurred rapidly, in less than one year. Members indicated that the perceived prestige of participation in the collaborative helped create incentives for change among their systems' leaders and was one of the top two reasons for success. The Medicare Innovations Collaborative approach can serve as a model for health service delivery change, ultimately expanding beyond the acute care setting and into the community and often neglected postacute and long-term care arenas to redesign care for high-cost Medicare beneficiaries.

Use of proton pump inhibitors and other acid suppressive medications in newly admitted nursing facility patients.

INTRODUCTION: Many patients are not only prescribed proton pump inhibitors (PPIs) or other acid-suppressive medications (ASMs) during their hospital stay, but are discharged to the nursing facility on these medications. We wanted to quantify the amount of acid-suppressive prescription in new admissions, and how many patients had diagnoses that would justify their use. METHODS: A chart review of 98 admissions to a 128-bed for-profit nursing facility in Pennsylvania was performed to assess how many patients were transferred on a PPI or H2 blocker. Data were collected on age, sex, and any diagnoses relevant to the prescription of a PPI. RESULTS: Sixty (61%) of 98 patients had a PPI on their transfer orders to the skilled nursing facility (SNF). An additional 3 patients were on an H(2) receptor antagonist, totaling 64.3% prescribed acid suppression therapy. Only 30 patients (50%) had an appropriate diagnosis in their medical record justifying prescription of an ASM based on our criteria. In addition, 3 (3.1%) of 98 patients had a qualifying diagnosis in their medical records, but were not on PPI or H2 receptor antagonists on admission to the SNF. CONCLUSION: Many patients admitted to an SNF may be prescribed acid-suppressive therapy with no clear indication. Inappropriate use of PPI therapy should be minimized as overuse will not only increase drug costs, but also the risks of drug side effects and polypharmacy.