Aging In Texas Conference

Houston 2013Sunday-June 16, 2013

Don Smith, M.A.Sherry Simon, R.D.N./L.D.

Reducing Hospitalizations with Registered

Dietitians Visiting Home-bound

Clients

Presentation Objectives:• Learn about the history and focus of

the project

• Understand the tools used and how to implement them

• Develop a list of potential collaborators including evaluators

History and Focus• United Way of Tarrant County Emerging

Issue

• Increase in incidence of Diabetes

• $20,000 Seed Grant – 2007

• Awarded to Meals On Wheels, Inc. of Tarrant County

History and Focus Continued• Program Continues 2008 – 2010

• Related program integrated into AAA Community Living Program

• Over 7,500 screened or counseled

• Administration on Aging Award – 2008

• 1st Place Innovation Award from National Association of Area Agencies on Aging -2009

History and Focus Continued• “Healthy Aging and Independent Living (HAIL)”

chosen as focus by UW Strategic Planning Committee – Summer, 2009

• HAIL Strategic Design Group formed – September 2009

• Five Meetings – November 18, 24, December 1, 9 & January 12, 2010

• Review of evidence-based interventions

• Prioritization of strategies

• Approved by UW Strategic Planning Committee (February 24, 2010) and Board (March 23, 2010)

History and Focus Continued• 1 in 5 health care dollar is spent on diabetes

• 23% of older Texans and 34% of minority Texas have diabetes

• Average diabetes hospital stay = $25,000

• Diabetes creates increased risk of • Blindness• Amputation• Death

• Type II diabetes is being diagnosed at younger ages

History and Focus ContinuedKey “Healthy Aging and Independent Living (HAIL)” Strategy: Diabetes Screening and Intervention  • screen homebound consumers and to make

referrals for those at risk of diabetes to a registered dietician for individually customized nutrition education and counseling

• identify at-risk individuals and helps them spend fewer nights in the hospital, with fewer visits to the emergency room

History and Focus Continued• Formation of HAIL “Renegade” group -

2011

• Identified short and intermediate outcomes

• Expanded strategies and target groups

• Developed outcome measurement tools

• Initiated at beginning of third year

History and Focus Continued• HAIL funding approved through 2020

• Expanded use of Registered/Licensed Dietitians (one of which is also a Certified Diabetes Educator)

• Hospitals • Managed care

Wall Street Journal Article:No One Fix to Slow Hospital Readmission Epidemic

• Please take 5 minutes to read the article

• What are the highlights?

• What is missing from the article as a possible intervention(s)?

• How can Meals On Wheels organizations get involved?

• How are Meals On Wheels organization a business collaborator to hospitals?

Preventable Hospitalizations in Tarrant County 2006-2010Source: Texas Department of State Health Services

Diagnosis Number LOS Cost

Angina 976 2.7 days $22,015 / $21,486,902Asthma 5,174 4.5 days $23,933 / $123,829,834Pneumonia 16,550 5.8 days $30,802 / $509,775,849CHF 17,067 5.4 days $31,285 / $533,948,574COPD 9,847 5.6 days $30,335 / $298,710,186Dehydration 3,261 3.8 days $18,697 / $60,970,718Diabetes-Long

6,751 7.1 days $37,894 / $255,821,504

Preventable Hospitalizations in Tarrant County 2006-2010Source: Texas Department of State Health Services

Diagnosis Number LOS CostDiabetes-Short 3,805 4.0 days $24,328 / $92,567,510Hypertension 3,416 3.4 days $22,732 / $77,652,260UTI 10,175 4.7 days $21,753 /

$221,335,638

Total to Tarrant County----$2,196,098,975

Why Need Evidence-Based Tools and/or Programs

• Efficacy of the intervention has already been demonstrated

• Using existing resources may save time and money

• Already have data to use as a benchmark

• You do not have to reinvent the wheel

• Many evidence-based interventions have developed tools that will assist you with tailoring an intervention and/or program to meet you organization’s needs

Why Need Evidence-Based Tools and/or Programs

• Efficacy of the intervention has already been demonstrated

• Using existing resources may save time and money

• Already have data to use as a benchmark

• You do not have to reinvent the wheel

• Many evidence-based interventions have developed tools that will assist you with tailoring an intervention and/or program to meet you organization’s needs

Meals On Wheels, Inc. of Tarrant CountyWheel of Services

Key:

Red Tabs---United Way FundedPrograms:HAIL-Nutrition & DiabetesHomeMedsPAMNeighbor Helping Neighbor

Green Tabs---Other MOWI Programs:Friend to FriendClient ServicesCompanion Pet FoodSupplemental Groceries

Live Well-Healthy Aging Independent Living (HAIL)Kathie Robinson, MS, RD/LD, CDE; Lynn Vargas, R.D./L.D.; Julie Langeberg, MS, RD/LD

HAIL-Diabetes and Nutrition Identification and Counseling Program---

This project aims to keep people healthy at home and reduce preventable

hospitalizations and emergency room visits, ultimately saving taxpayer dollars. The

clients are mostly referrals from Meals On Wheels, Inc. of Tarrant County, are aged 35 years and older, and have either a diagnosis

of or are at increased risk for diabetes or increased nutrition risk. In addition to

English, the project serves clients who speak Spanish and Vietnamese.

Project Overview HAIL initiative started as a strategy by the United

Way of Tarrant County to help people with chronic disease and their caregivers to live well in their community for a longer period of time and avoid institutional placement or hospitalization

HAIL has now has seven prongs which Meals On Wheels just implements three of the seven

July 2010, Meals On Wheels was awarded funding for implementing a HAIL initiative targeting diabetes and nutritional risk screenings and interventions strategies for the clients we serve

Project Details---Outputs To screen 3000 clients annually for Diabetes

Diagnosis and/or risk and Nutritional Risk using proven screening tools

To provide more in-depth services including home visits with comprehensive nutritional assessment and nutrition and/or diabetes education to 1250 clients

To make 1500 follow up calls

----All done in a effort to reduce client hospitalizations and emergency visits to ultimately save tax payer dollars

Project Goals---Outcomeso Reduce hospitalizations and ER visits by 10% for 6

months after interventions compared with 6 months before intervention

o Enhance health status and capacity for self-care, measured using evidenced-base tools and EQ-5D and Perceived Competence Scale for Health

o Improved body mass index based on self-reported height and weight at 1 year after intervention

o Decrease nutritional risk score based on Nutrition Checklist for Older Adults (DETERMINE) screening tool at 1 year after intervention

Project Flow MOW Case Managers complete screening tool of the DETERMINE; a Diabetes

Risk Screen Tool; Risk Factors for Hospitalization and Emergent Care Assessment on all MOW clients annually.

Clients are then categorized into high, moderate, & low risk based on screening tools by project Dietitians

Dietitians calls clients to set up appointments to meet with them in their home.

Dietitian completes a full nutrition assessment; clients set behavior goals; dietitians complete documentation & formalizes education plan.

Nutrition education materials are mailed to each client’s home and based on individual needs.

Dietetics students follow-up with the initial nutrition assessment; ask about their performance on behavior goals and perform nutrition education over the phone.

Follow-up home visits are done by the Dietitians for clients most at risk All data is maintained on our MOWI database and updated per the project

requirements from the funder An independent evaluation team involved to verify outputs; measure

outcomes; look for correlations of the data; and work to prove the efficacy of the project

Project Tools

• DETERMINE Nutrition Tool• Diabetes Detective Initiative Tool• Risk Factors for Hospitalization and Emergent Care Assessment• EQ-5D• 2011 NHIS: Family Access to Health Care and Utilization• 2008 NHIS: Family Health Status and Limitation• Height, Weight, Body Mass Index• Behavior goal tracking• MOWI Database• Evaluator Reporting

Cost Benefits

Average cost of hospitalization for complications w/diabetes:

$21,000-$30,000

Cost of RD visit per HAIL client to date$155

Source: txpricepoint.org

Marketing Your Success Share with all your stakeholders

Quantify results into dollars

Write press releases

Ask your clients to participate and help you tell your successes

Tell client stories

Complete at least monthly reports to share with stakeholders

 

Questions and Answers

Email me if you would like a copy of the presentation or if you would like any materials at:Ssimon@mealsonwheels.org