Lou Ann Wilroy, CEO

One of the top focus areas currently for CRHC’s Program Director, Michelle Mills, is leading our iCARE program. I’m very excited about this effort because it represents a new high point for our quality improvement work.

The iCARE (Improving Communication and Readmission) project’s focus is on reducing costly hospital readmissions among our state’s Critical Access Hospitals (CAHs). Readmission is often considered to be an urban problem. While it is true that the smaller healthcare systems don’t struggle as much with hospital readmission as larger ones, systems large and small can improve on this front.

For hospitals of all sizes, readmissions are especially a problem for patients struggling with pneumonia and heart failure. Unplanned readmission to hospitals cost the government about $17 billion annually, according to a recent study in the New England Journal of Medicine. The study found 2.3 million, or 20%, of Medicare beneficiaries were readmitted to the hospital within 30 days. The majority of those readmissions were related to issues such as heart failure and pneumonia.

At CRHC we understand that rural hospitals operate differently than their urban peers, so our readmissions/care transitions program is different too. In short, iCARE is not as prescriptive as many other readmission efforts because we appreciate that rural facilities need more flexibility in how they participate in quality improvement programs.

While communications in rural facilities might be less challenging due to their smaller size, the handoff to large urban facilities is a different equation, one that too often results in readmissions. The iCARE program is focused on implementing protocols that make the rural/urban transfer more predictable and thus less likely to result in a readmission.

Because paramedics play such a critical front line role in rural areas, Michelle Mills and the other members on our iCARE team are intent on making sure these professionals are part of the solution to readmissions. According to Michelle, “the iCARE program is based on CRHC’s strong understanding that the entire community plays a role in offering patient centered care.”

Of course our care transitions team is not skipping past the basics. Discharge instructions and medication reconciliation are being scrutinized, as well as an examination at how closely those instructions are understood and followed. Because our rural facilities run from border to border, we will be using webinars to make program content accessible to all.

If you have questions, or would like to learn more, please get in touch with Michelle Mills at mm@coruralhealth.org. Michelle is participating in a statewide Hospital Readmissions Task Force that has been formed by the Center for Improving Value in Health Care. The Task Force is coordinating efforts like CRHC’s iCARE with other readmissions work such as the Colorado Hospital Association’s Project RED and the Colorado Foundation for Medical Care’s Care Transitions Program.