Arthur Garson, Jr., Director of the Health Policy Institute of the Texas Medical Center, recently posted a blog for Health Affairs reviewing how training programs, reimbursement changes, discharge plans, medication reconciliation and other policies can support nurse aides and community health workers reduce readmissions.
Garson details The Grand-Aides® program featuring rigorous training of nurse aides or community health workers to work as nurse extenders, five Grand-Aides to one RN or nurse practitioner (NP) supervisor, with approximately 50 patients per Grand-Aide per year. The Grand-Aides visit at home daily for the first 5 days post-discharge and then as ordered by the supervisor (e.g. three days the next week) for at least 30 days, extending as long as desired.
A recent review of data for a group of patients involved in the Grand-Aides program in the University of Texas Health System Consortium showed since January 2013, among 62 unselected Medicare patients with Class III-IV Heart Failure (HF), there was one HF 30-day readmission (1.6 percent) with one elective Coronary Artery Bypass Grafting, resulting in a HF-related 30-day readmission rate of 3.2 percent. Garson notes, "While the small numbers and historical controls make firm, statistically significant conclusions impossible, these results suggest that, the use of Grand-Aides may have helped reduce hospital readmissions, and that Grand-Aides could be a promising way to improve quality and health outcomes."