America’s Essential Hospitals, which represents more than 300 hospitals that care for low-income and other marginalized people, awarded Hennepin Healthcare the 2021 Gage Award for Quality Improvement for work to reduce readmission rates for those experiencing homelessness. This population is often unable to prioritize medical care due to competing priorities of daily survival and frequently has higher rates of emergency department and inpatient utilization. Studies report those experiencing homelessness are four times more likely to be hospitalized and at greater risk for readmissions and prolonged hospital stays. The association presented the award June 24 at its virtual annual conference.
Hennepin Healthcare’s efforts to reduce readmission rates was based on an analysis showing that housing instability was a major contributing factor to 30-day readmissions, affecting 75 percent of patient charts reviewed. Hennepin Healthcare partnered with Hennepin Health, a county-based accountable care organization (ACO), to proactively identify and respond to social determinants of health to reduce readmissions in the ACO population experiencing homelessness. As a result of this work, readmissions went down by 3.7 percent for the global ACO population over a 1 year period, and 12.4% for the target population that connected to services.
“This work speaks for itself and is the result of an entirely collaborative effort on so many levels,” explains Danielle Robertshaw, MD, Senior Medical Director, Hennepin Healthcare Community Connections and Medical Director, Hennepin County Health Care for the Homeless. “Homelessness remains a significant health-related social need that complicates care and leads to poorer outcomes. We partnered with community-based ACO care managers in the inpatient setting to help build rapport with patients, promote care continuity, and connect patients experiencing homelessness to social services. Hennepin Healthcare also developed a novel analytics tool to identify risk factors indicating housing insecurity to help us identify eligible patients.”
Heather Rhodes, PharmD at Hennepin Healthcare, submitted the application for the Gage Award. “We are so excited to receive this recognition, but have been realizing the benefits of this program since its inception in 2019. The teamwork, results, and how the interventions are making a difference for our patients make this so rewarding.”
“The COVID-19 pandemic and acts of racial injustice that have marked the past year magnified the role of our hospitals as healing forces in their communities, both inside and outside the hospital walls,” said America’s Essential Hospitals President and CEO Bruce Siegel, MD, MPH. “We are proud to recognize Hennepin Healthcare and its partner, Hennepin Health, and our other awardees for their continued efforts to innovate with limited resources and during challenging times.” The pandemic inadvertently revealed Hennepin Healthcare’s readmission reduction program’s success; when case managers could no longer safely visit inpatients, there was a rebound in readmission rates back to the pre-intervention baseline performance.
The Gage Awards, named after association founder Larry Gage, honor and share successful and creative member hospital programs that improve patient care and meet community needs. The Gage Award for improving quality recognizes activities that improve the quality of care or that mitigate threats to patient safety.
Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 484-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, and Whittier neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care and hospice, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.