Continuum of Care Quality Improvement Project

About the Program

Category: Health (Best in Category)

Year: 2012

Often, there are many barriers that prevent patients from moving through the healthcare system and being discharged, such as funding for the medically indigent, undocumented status, homelessness, age, obesity, behavioral problems, mental health diagnosis and/or active substance abuse issues. In response, Los Angeles County started their Continuum of Care Quality Improvement Project to aid these individuals. Interdisciplinary work groups were created to improve early identification of discharge needs (out-of-home placement and expedited linkage to funding for placement.) The team included staff form Clinical Social Work, Finance, Utilization Review and Home Health. Weekly meetings were held with six medical teams. Additional meeting were held with Family Medicine providers and ward/unit staff. Clinical Social work had weekly internal ‘Hard-to-Place’ Rounds. Patient discharges were expedited to decrease patients’ lengths of stay from 33 days to 23 days resulting in cost avoidance and increased revenue. There was a total decrease of 610 hospital days, a cost avoidance of $610,00.00 dollars. Forty percent of these days, the beds would have been filled by a MediCal patient, a projected revenue of $178,852.00