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Wright-Patterson Medical Center advancements in value-based care help lead the region

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Personnel from the Wright-Patterson Air Force Base Medical Center are leading the way in quality healthcare by inventing and implementing a new model of care to improve safety and efficiency for patients.

This new model, called the Military Acuity Model (MAM), was highlighted by researchers from Johns Hopkins University in a peer-reviewed article published Nov. 9 in the American Journal of Medical Quality.

The MAM, inspired by then-WPMC Clinical Nurse Specialist Maj. Jared Mort, focuses on planning ahead to ensure each health care professional is not mentally overloaded - or task-saturated, which would otherwise lead to errors.

"Reducing task saturation improves the process of care, as it ensures better completion of care-related tasks and thereby increasing safe patient outcomes," noted Mort. "This is crucial with preventing future problems and getting patients well sooner."

In the article, "A Tale of Two Systems: Combining Forces to Improve Veteran and Military Health Care," the researchers, who worked with co-inventors Col. (Ret.) Douglas Howell, Maj. Ross Birdsong and Mr. Terry Rajasengn of the Air Force-inspired  MAM, discuss how dramatic improvements in effectiveness and patient safety can be achieved by looking at healthcare in different ways. This new model focuses on planning ahead to ensure each health care professional is not mentally overloaded--or task-saturated--which would otherwise lead to errors.

The researchers focused on the concept of High Reliability Organizations, an emerging standard of safety that has been applied to aviation and nuclear industries to reduce the risk of serious errors.

Given the growing complexity of patients that the WPMC and its partner U.S. Veteran's Affairs (VA) facilities are facing, this standard is especially crucial.

To illustrate, one aspect of patient safety is the prevention of Failure to Rescue (FTR) events. An FTR event is where the healthcare team is unable to stop a preventable death.

Based on Leapfrog estimates of medical error fatalities around the nation's hospitals, the rates of FTR are at least twenty times higher than at WPMC. Inpatient services at the medical center reduced its FTR rates by 87% in one year. Although the complexity of the patient population increased in key areas such as Internal Medicine and Family Medicine, these rates were dramatically reduced by better managing task saturation.

Mort's new approach to harnessing nursing teams as well as support teams more effectively is also being applied beyond just patient safety and "hospital acquired conditions."

Maj. (Dr.) Aven Ford and his wife, Maj. (Dr.) Caelan Ford, both neurologists at WPMC, are helping lead the expansion of Mort's methods throughout WPMC clinics.

Instead of spending time on preventable problems, medical teams are able to spend more time at the bedside, therefore helping WPMC achieve a five-star patient satisfaction assessment rating from Hospital Consumer Assessment of Healthcare Providers and Systems. This rating places the medical center in the top six percent of the nation's hospitals.

With regard to efficiency, Maj. (Dr.) Aven Ford said, "Inpatient metrics such as patient satisfaction and readmission rates can be improved via outpatient performance, which is helped through the use of these strategies. 

The avoidance of readmissions is another measure of quality of care and efficiency. This occurs when discharged patients must come back to the hospital too soon for a related problem. The efforts at WPMC lowered readmission rates in 2014, allowing more patients to be seen in a timely manner.

Also affecting quality is the continuity of care. WPMC and its partner VA facilities have a unique advantage over other alternatives for active-duty and veteran patients. The Joint Legacy Viewer Electronic Health Records (EHR) enables care teams at partner facilities to see all the issues the patient has faced during their encounters at both military and VA facilities. Therefore, because WPMC's care team knows their patients best, keeping them within WPMC and its partner VA facilities improves the care for their patients.

Process of care, outcomes, patient satisfaction, and cost efficiency measures, such as reducing repeat visits, are considered by the Centers for Medicare and Medicaid Services to be components of Value-Based Purchasing. Thus, WPMC has demonstrated its excellent value-based care relative to all hospitals in the nation, and continues to strive to improve its already outstanding care to better serve its active duty and veteran populations.

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