Foundation rolls out medication management model for home health providers

Partners in Care Foundation (PICF), a Burbank, Calif., non-profit organization that assists healthcare providers and community-based organizations to develop new ways of delivering care, is ready to disseminate a Medication Management Model program to home health providers. This project is funded by a grant awarded by The John A. Hartford Foundation Inc., New York City.

According to June Simmons, president/CEO of PICF, the grant was awarded based on a demonstration project that improved medication use and reduced medication errors among elderly home health patients.

"We were just funded to do the second stage of work, which includes replicating the model in four leading sites in the nation and creating a tool kit that other sites can use to install the model," said Simmons. "The Corridor Group, a premier consulting group in home health, is being trained in the model so it can disseminate it to its clients as well."

Simmons said the four sites will most likely be large agencies located in large cities and that they will be selected in the next six to eight months. The agencies will receive funding to train their staff. "We hope the four agencies are a catalyst. We feel if we can introduce this new program in a few respected agencies throughout the country, they will spark that same dynamic in their local communities. Others will see a better way of giving care and will have to rise to it. The four are a force for change that will raise the level of practice in their region," said Simmons.

The tool kit includes a Web site that describes the model and gives instructions on installation of the program. It addition, the kit provides training tools and protocol to enable agencies to develop a business plan, engage a consultant pharmacist, train staff, and communicate with local physicians.

In 1997, the foundation provided funding for an intervention project conducted at Vanderbilt University in conjunction with the Visiting Nurse Associations (VNA) of Los Angeles and New York. For the Vanderbilt/VNA demonstration project, the project team first surveyed medication use among Medicare patients who were admitted between 1996 and 1998 to the VNA of Los Angeles and the VNS of New York.

Of the 6,718 patients included in the project, 19% had experienced at least one possible medication error, according to home health criteria developed by a panel of home health experts. Another 17% had experienced at least one medication error according to Beers’ criteria (criteria established as part of the long-term care Medicare Omnibus Budget Reconciliation Act). When both sets of criteria were considered, 30% of patients had experienced a possible medication error, according to Simmons.

Simmons explained, "We found out we were able to cut the error rate in the targeted medications by half. So we helped improve the safety and the comfort of managed home health patients and developed a very cost-effective model others can use to improve care all across the county. The elderly are at risk. They usually have more than one chronic condition, and if each condition requires some medications, it’s fairly easy to have a series of specialists caring for you who may not even know about all the medications you are taking. It’s easy to end up with poor combinations because one physician doesn’t know about the other physician unless a patient reports it."

Dennee Frey, Pharm.D., project director, PICF, said a consultant pharmacist reviewed the high-risk medications and alerted physicians when a problematic combination of medications was identified.

"The new grant for disseminating results and encouraging use of the new clinical model will have practical value for home health agencies by controlling risk for medication errors that could result in extended stays for care and meeting quality improvement requirements. Because of the severe nursing shortage in home health, there’s an opportunity for pharmacists to use their expertise in home health and augment the duties of the nurse," said Frey.

Sandra Levy

Sandra Levy. Foundation rolls out medication management model for home health providers.

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