Data shows DN good place for home health
Del Norte County residents have one choice when it comes to home health care: Sutter Coast.
Despite the rural location and lack of competition, the Crescent City-based department of Sutter Coast Hospital exceeds or meets statewide averages in 12 of 21 categories posted at Medicare Home Health Compare.
Sutter Coast led the North Coast in timely service, posted a perfect 100 percent of clients with post-operative wounds improving or healing, and significantly bested the state average in keeping hospital readmission rates low.
Most impressive: it put the rest of the state and Humboldt County’s two home health agencies to shame in improving clients’ ability to breathe, a key quality of care measure for patients with congestive heart failure and chronic obstructive pulmonary disease.
Sutter Coast’s 79 percent mark compared favorably to the statewide average of 66 percent and the 64 percent posted by Mad River Community Hospital’s Home Health Services in Arcata.
As for St. Joseph Home Health Care in Eureka: not even close. Sutter Coast improved breathing ability in four of every five clients. St. Joseph’s 52 percent meant slightly more than one of every two clients improved.
Jeanine Sollom, registered nurse and quality manger for St. Joseph Home Care Network-Humboldt, said chronic respiratory illness is a problem in the patient population and said the St. Joseph health system is working to improve that score.
They can only hope for the improvement Sutter Coast has shown since its 2011 introduction of a telephone monitoring program for patients with congestive heart failure and chronic obstructive pulmonary disease.
“Nothing fancy. No monitors in patient homes,” said Melissa Ford, clinical supervisor and registered nurse with Sutter Coast.
Instead, Sutter Coast Home Health has a schedule of every client with a CHF or COPD diagnosis and places each in the monitoring program unless the client refuses to participate.
“We call them daily for the first 14 days they are on service, except for the days they are getting a nursing or physician visit,” Ford said. “Then we do it weekly thereafter throughout their episode of care.”
Each call follows a scripted set of questions about weight, shortness of breath, cough, fatigue, swelling, pain and dizziness.
“If we can catch symptoms before they go back to the hospital, then we are saving them a hospitalization,” Ford said.
If the patient is discharged, the weekly calls continue until the end of what Medicare calls an episode of care — 60 days.
“If they are having issues in any of the areas, we can get hold of the doctor right away and try to get it managed before the symptoms caused an exacerbation,” Ford said. “Even if the patient is no longer on our service, we will send the doctor an FYI fax. Then the physician will follow up with the patient.”
Low hospital readmission rates are characteristic of all three North Coast agencies. St. Joe’s home health clients were admitted only 16 percent of the time; Sutter Coast’s 19 percent and Mad River’s 21 percent.
The state average is 24 percent and the national mark is 27 percent.
Coastal Home Health and Hospice in nearby Brookings came in at 24 percent and served clients in a timely manner 81 percent of the time compared to Sutter Coast’s 95 percent. Coastal is not licensed to serve clients in California, but Sutter Coast provides services in Brookings — although no one would know that looking at the Hospital Compare website.
“I used to be able to pull myself up and compare directly to Coastal, but that stopped within the last six months. Something to do with borders and licensing,” Ford said.
To compare the two now requires two open screens on the Home Health Compare website.
Sutter Coast’s biggest misses came with an 84 percent mark compared to the state’s 92 in teaching patients or family caregivers about their drugs and in checking the patient’s risk of falling, 82 percent to 97 percent.
Mad River’s Brenda Goosby, an out-of-area home health director in Walnut Creek, said misunderstanding over an acceptable measurement tool for fall risk contributed to problem scores in that category, and not just at Mad River and Sutter Coast Home Health.
Even so, Ford said the physical therapy department is now responsible for fall risk and is doing staff education to “create specific goals pertinent to each patient,” Ford said.
As for teaching about medication, Ford said the staff is redoubling its efforts in that category.
“At the start of care, we have the nurses look at patient medication bottles. It doesn’t matter if it’s over the counter or prescriptions. We ask to see everything they are taking — and that can be buckets.”
The nurse matches that list with the discharge list of medications and reconciles the differences.
“Often you ask the questions one visit and then the next time they have a mystery bottle that appears out of nowhere,” Ford said. “The goal is to have patients improve at taking their own medication.”
Medication errors are among the most common medical errors, harming at least 1.5 million people every year, said a 2006 report from the Institute of Medicine of the National Academies.
All three North Coast agencies were 8-12 percent better than the state average for providing flu and pneumonia shots to their clients.
“I would like people to look at the website,” Ford said. “It’s meant for a patient to be able to say, ‘Hey, I’m a little concerned that you are not doing what you should be doing in this area. How can I make sure I am getting the best care possible in this area?’”
The Home Health Compare site was updated April 19. The categories reflect data for January through December 2011, or for July 2010 through June 2011.
To find Home Health Compare, go to: http://www.medicare.gov/HomeHealthCompare/search.aspx.
Remember: the website reflects a snapshot in time using data anywhere from five to 22 months old.
“Whatever the numbers say it will boil down to someone’s individual experience,” said Margot Julian, a Eureka resident and home health client who once served three years in quality management at St. Joseph Hospital in the late 1990s. “Most of us don’t care if it is one out of 10 or one out of a million because for each of us, it’s one out of one.”