IPRO
The Path to Community Partnerships for End-of-Life Care
IPRO and WNET-13
In 1999, IPRO, New York State's Quality Improvement Organization completed a Healthcare Quality Improvement study that demonstrated low usage of advance directives by patient's and healthcare providers in New York State. The study found that advance directives are not widely understood or used. In the development of a QIO Quality Improvement Study, partnerships were formed to further expand the information base on the study area and provide more extensive consistent community outreach opportunities to focus attention on the subject, in this case, End-of-Life Care. IPRO was already working with the New York State Coalition on End-of-Life Care and was invited to participate in Channel 13 WNET's Community Outreach Program for "On Our Own Terms" Moyer's on Dying in America.
IPRO's participation in WNET's Community Outreach Program involved conference calls, meetings and brainstorming with "On Our Own Terms" program staff and other community participants. A guidebook was produced by the WNET Community Outreach Team to assist partners/participants in determining the scope or level of their own participation within their area of capability and expertise. Suggested activities ranged from small group discussions, screening events with legislators, town meetings, community action campaigns, working with local healthcare providers, community advocates, religious ministries and work place educational initiatives.
IPRO held a Town Meeting in its own headquarters in order to provide a local focus on End-of-Life Resources in the Long Island area, specifically the counties of Nassau and Suffolk. Eldercare attorneys, legislators, representation from a local Hospice network, a physician from Continuum Cancer Centers of New York and from the New York State Partnership to Improve End-of-Life Care all agreed to participate in the Town Meeting.
IPRO chose to use the Town Meeting to focus attention in the area of End-of-Life Care and because it was felt to be an appropriate approach consistent with Quality Improvement Organizations consumer and provider education activities.
The Town Meeting was successful, garnered media attention and combined the event with the development of a local End-of-Life Care resource directory posted on IPRO's website, www.IPRO.org. It also helped to identify the Quality Improvement role as a resource in meaningful ways to healthcare consumers and family caregivers.
Depression and Heart Disease
Experts observe that Western medicine focuses intensively on high tech medicine but does not bring the same level of attention to the psychological aspects of disease. It is becoming increasingly evident that behavioral health interventions have a positive impact on medical outcomes, especially in the area of cardiac care and rehabilitation. A unique quality improvement study undertaken by IPRO, the Medicare-funded Quality Improvement Organization for New York, promotes aggressive depression screening in the cardiac rehab setting, with appropriate follow-up treatment/referral in order to offer truly comprehensive care to patients in need.
The New York State Acute Myocardial Infarction (AMI) Depression project is a voluntary collaborative involving IPRO and more than 60 cardiac rehabilitation facilities in New York State. The goals of this project include universal screening for depression among cardiac rehabilitation facilities in New York to increase appropriate treatment and/or referral of cardiac patients who are at risk for depression. This project is accomplishing its goals through data driven-process improvement, creation and dissemination of educational resources, and sharing of best practices among all participants.
The AMI/Depression project has already demonstrated improvement for the following quality indicators:
* Percentage of cardiac rehabilitation patients who are adequately screened for depression,
* Percentage.of patients "at risk" for depression who receive further evaluation, referral or treatment for depression,
* Percentage of patients who demonstrate improvement between initial and subsequent depression screenings.
The activities conducted to address these quality measures have included creating a comprehensive toolkit of materials that providers are using to foster depression screening and education, building a user-friendly website focusing on AMI and depression located at http://www.cardiacblues.com (available through www.ipro.org) and chairing a series of topic-specific provider training conference calls. IPRO project managers have pioneered development of a comprehensive assessment tool, engaged in extensive medical chart reviews and made site visits to all participating rehab centers.
IPRO had already found significant improvements in its quality improvement indicators even prior to intervention completion. "Cardiac rehab staff have known for years that depression is a problem for their patients; we believe our project has jump-started the effort to better integrate behavioral and medical treatment approaches," according to Scott Crespy, Ph.D., Project Manager, IPRO.
Cardiac rehabilitation centers offer a broad range of services, and treat patients from many walks of life. This unique health care setting presents an opportunity to film real people in real situations with serious health issues. (Note: IPRO has identified an articulate, engaging cardiac patient, a provider by training, who would be an excellent subject to personalize the depression and heart disease story.)
"The medical community is becoming increasingly aware that depression is a strong predictor of cardiac morbidity and mortality," added Charles E. Stimler, M.D., M.P.H. Medical Officer at IPRO. "Providing additional education to both providers and patients at this time can make a substantial difference in the future of mental health involvement in cardiac care."
IPRO is pleased that this cutting-edge project is receiving strong support from healthcare providers in New York and is now viewed as a model for QIOs around the nation. The U.S. Centers for Medicare and Medicaid Services (CMS) has indicated it is thinking seriously of funding similar projects around the nation, for QIO workplans beginning in 2005.
