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Measuring Time: A Perspective on Long-term, Post-Acute Care

It is common for us to share same moment of time.  Uncommon for any of us to measure that moment equally.  Some of us will measure it out with coffee spoons. Others with a slumbering thought.  Julian Barnes describes it perfectly in his book, The Sense of an Ending

“I know this much: that there is objective time, but also subjective time, the kind you wear on the inside of your wrist, next to where the pulse lies. And this personal time, which is the true time, is measured in your relationship to memory.”

In the health care industry, it is also common for us to measure time for many different reasons.  Sometimes it is measured in minutes, whether to mark a pulse or the maximum number of exam room visits that can be fit into an hour.  Sometimes it is measured in days, whether the number of doses of medication needed or time in an ICU bed.  Sometimes it is measured in months, whether a prognosis or time in accounts receivable.

But for many of those that provide care in long-term, post-acute care (LTPAC), time is often measured in years and it radically impacts their relationship with those for whom they provide care.  As health care leaders look to excel in a value-based reimbursement environment, that perspective on time may be one of the most enduring lessons to learn for those across the continuum of care.

And there is good reason that lesson is urgently needed.  Roughly 10,000 baby boomers turn 65 every day.  They will keep doing so for another 13 years.  Chronic conditions like obesity, diabetes, high blood pressure & cholesterol are more common amongst the baby boomer generation than the generation before it.   This is happening at the same time as medical and technological breakthroughs that continue to extend our life spans.  In this reality, does the paradigm from which we created the 15-minute physical exam appointment really make sense anymore?

Chuck Czarnik, Vice President, Strategic Planning at Brookdale Senior Living, doesn’t seem to think so.  Speaking with Rod Piechowski during STEPS to Value season two opening episode “The Value of “People” vs. “Patients”: Understanding Long-Term, Post-Acute Care (LTPAC)”, Chuck describes the nature of the data currently captured in acute care settings and the opportunities for a more holistic understanding of a person’s life goals as they relate to their health care.  Talking about a resident patient who wanted to attend their great-grand daughter’s wedding, Chuck describes the impact sharing those life goals with other care providers can have for the patient’s experience throughout the continuum of care.    

“If we have been caring for someone for weeks, months, years, we know something about that patient, about their needs their wants their desires...I am looking for policies and technologies that allow us to capture those goals and those needs of the resident patient in the LTPAC setting and pass them back our upstream care givers, so we are all playing from the same playbook.  Today, most of the technologies, the standards policies that have been developed are focused on very discrete, kind of, sterile clinical elements, medication lists, vitals, the demographics, and that is all very important information, but there is a lot we know about these residents that if we had a means to communicate those in a structured meaningful way back up the chain as the residents move throughout the healthcare continuum, I think our segment of the industry could definitely add value”

As the health care industry continues to respond to an aging population with more long-term health care needs, how does it ensure that it best supports patients as they transition between ambulatory, acute, and long-term, post-acute care settings?  What does patient engagement look like for like for patients that might not have the agency to participate in their care, such as the 5.4 million Americans with Alzheimer’s disease?  As more and more people receive care in the home, at skilled nursing, rehab and assisted living facilities, how do health care providers ensure that they are working as a team to care for the person, not just the patient?  What is it like to view your care encounter in terms of years vs. hours or minutes?  How does that change your organization’s perspective on patient engagement?  How can dedicated, broad group of care givers across the continuum use health IT and innovative processes to facilitate better transitions of care?  We want to hear from you.   Let us know about the people, organizations & initiatives that driving value in the relationship between acute & long-term post-acute care space.  Send us your thoughts at value@himss.org

Keywords: 
HIMSS; healthcare; patient engagement