Prevention is the Best Medicine

By A Adam Andres, MD

When my partner, Dr. Jeremy Kirk, and I co-founded ARMS we had a simple goal: to provide high quality medical care to patients in nursing homes. Too often as hospitalists (physicians devoted to inpatient hospital care), we would treat patients in the hospital, discharge them to a skilled nursing facility for continuing care, only to see them return to the hospital again in a few days or weeks with complications. Clearly these patients needed a higher level of care after their hospital stay.

The care patients received in a nursing home was beyond our control, that is, until we began to reach out to these facilities to help them develop medical protocols that aligned with our continuing care model. Our first step toward improving care in our partnering nursing facilities has been to emphasize being pro-active. Historically, some nursing homes lacked strong medical direction and were more likely to “react” to illnesses or complications in their patients rather than taking steps to prevent complications in the first place.

ARMS has been able to deliver better preventive care by making ourselves more available to patients, and nursing home staff 24 hours a day. We conduct regular patient rounds and get to know the individuals who entrust us with their care. By establishing a strong presence at our partnering nursing facilities, we also have the opportunity to get to know our patients and their conditions. This approach supports an unprecedented continuity of care. We also nurture our relationships with nursing staff, so they feel confident in their abilities and comfortable talking to us about patient care. If a problem does arise, nursing staff can talk to us directly so we can work together to resolve issues for our patients.

Now that ARMS is well-established and partnering with several central Indiana nursing facilities, we have seen dramatic improvements in hospital readmission rates among our patients. Before partnering with ARMS, it was not uncommon for some nursing facilities to send approximately 20-30% of their patients back to the hospital within their first 30 days. With the ARMS care model in place, our partnering facilities now send only 8.8% of patients back to the hospital within 30 days – this is less than half of the national average for 30-day readmissions. Clearly, the ARMS approach is making a difference for patients!

Hospital readmission rates are a great indicator of the quality of care a skilled nursing facility is providing. Most of these post-acute facilities are capable of providing near hospital-level interventions (such as IV fluids) when needed. The key is providing them in an appropriate way and at the appropriate time. Since ARMS physicians all have acute care experience, we know what treatments we would provide in the hospital, so we can provide that same care in a nursing facility, without costly hospital readmissions and recovery setbacks for our patients. And, once again, the familiarity and continuity of care we have with our patients allows us to make more informed decisions and offer the best possible preventive care outside of a hospital setting. The end result is higher recovery rates and improved quality of life for our patients. Nothing is more important than that.

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