Peer Support for Addiction in the Inpatient Setting

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered with North Suffolk Mental Health to embed two Recovery Coaches in the Emergency Room and Inpatient setting to support and engagement and navigation into treatment for patients presenting to the hospital with addiction. Aims: The aim of this study is to describe Year One of the Recovery Coach pilot project, with recommendations for improvement to inform further program growth. Method: The population of patients who worked with a Recovery Coach in Year One is described in terms of demographic information, insurance status and ACO attribution. Semi-structured interviews of patients, Recovery coaches, staff, providers, and administrators were conducted to extract qualitative themes among the stakeholders. Results: The average patient is described as a 44-year-old, white, low-income, English-speaking male living in a surrounding community with Alcohol use Disorder. Themes emerging from interviews indicate positive support for the program from all stakeholder perspectives. Strong themes of value in patient engagement, Recovery Coach empowerment, and influence on staff and provider work satisfaction emerge, as well as several areas of opportunity for program improvement. Conclusions: The findings of this study provide valuable stakeholder input that will improve the program and inform its expansion. The findings should not be generalized to other programs, as the CHA inpatient-based Recovery Coach model is different than other programs described in the literature. However, this study may be of interest to another hospital planning to develop an inpatient-based model

The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

Scaling Up: Bringing the Transitional Care Model Into the Mainstream

Describes features of an innovative care management intervention to facilitate elderly, chronically ill patients' transitions among providers and settings; the adopting organization; and the external environment that affect its translation into practice

Quality of End-of-Life Cancer Care for Medicare Beneficiaries

The report shows that many challenges remain to improving the care of patients with serious, life-limiting illness. For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States

Why Not the Best? Results From a National Scorecard on U.S. Health System Performance

Compares the national average healthcare system performance to benchmarks of higher performance. Provides a mechanism for monitoring change over time across goals of health outcomes, quality, access, efficiency, and equity

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008

Assesses the U.S. healthcare system's average performance as measured by thirty-seven indicators of health outcomes, quality, access, efficiency, and equity. Analyzes trends compared to the 2006 scorecard and to international benchmark rates