Transitional care innovation for Medicaid-insured individuals: early findings.

BACKGROUND: Chronically ill adults insured by Medicaid experience health inequities following hospitalisation. LOCAL PROBLEM: Postacute outcomes, including rates of 30-day readmissions and postacute emergency department (ED), were higher among Medicaid-insured individuals compared with commercially insured individuals and social needs were inconsistently addressed. METHODS: An interdisciplinary team introduced a clinical pathway called 'THRIVE' to provide postacute wrap-around services for individuals insured by Medicaid. INTERVENTION: Enrolment into the THRIVE clinical pathway occurred during hospitalisation and multidisciplinary services were deployed into homes within 48 hours of discharge to address clinical and social needs. RESULTS: Compared with those not enrolled in THRIVE (n=437), individuals who participated in the THRIVE clinical pathway (n=42) experienced fewer readmissions (14.3% vs 28.4%) and ED visits (14.3% vs 28.8 %). CONCLUSION: THRIVE is a promising clinical pathway that increases access to ambulatory care after discharge and may reduce readmissions and ED visits.

Meeting the challenge of managing vaso-occlusive crisis.

Quality improvement efforts in patient care are most successful when the entire healthcare team is involved in care planning. This article discusses a multidisciplinary approach to the development of a protocol for patients with sickle cell disease experiencing vaso-occlusive crisis. The protocol's goal was to improve the quality and consistency of care for these patients. Outcomes, which were based on data from the 6 months before and after the protocol initiation, demonstrated an increased treat-and-release rate from the emergency department, a decreased average length of stay, and a decrease in the percentage of patient days down-graded by payers.