Adherence Management

Improving Patient Adherence: Changing the Conversation!

Are we asking the right questions about hospital readmissions? Are care providers and ACOs performing the correct behaviors that will promote a positive change in their patients?

Included in this paper is a comparative analysis of tools and change packages currently in use in hospitals around the country to address patient adherence in order to reduce patient readmissions.  These tools include the LACE, Top Ten Checklist, Project BOOST 8P Screening Tool and the Transitional Care Model.

Adherence Management (AdM) is a behavior change package, intended for hospitals participating in the Hospital Engagement Network (HEN) 2.0 project led by the Centers for Medicare & Medicaid Services (CMS) and the Partnership for Patients (PFP), to be adopted as a tool to supplement the above by reducing unscheduled readmissions and improving care transitions.

This change package is an introduction to the use of applied behavioral science based with almost four decades of successful practices.  Adherence Management extends beyond recognizing who is “at risk” and offers providers the tools to change patient behavior and improve adherence.

CMS implemented the Medicare Hospital Readmissions Reduction Program that penalizes hospitals for excess readmissions. As such, hospitals face a financial and moral imperative to reduce unplanned readmissions, ultimately resulting in improved outcomes and experience for patients. 

Punishing providers for the patient’s decisions NOT to follow the plan of care may have a slight impact on readmissions because it forces providers to change behaviors rather than the patient, and the consequences of these provider behavior changes will most likely hover well below the expected 20% reduction.  If a sustained impact is to be developed, then the conversation needs to change

Reducing readmissions begins with changing the behavior of the patient and sustained behavior change requires the use of positive reinforcement.   As much as we would like to believe that education programs provide patients with the information they need to be successful, the results tell us quite the opposite.   

The content of this paper includes:

  • Part 1: Improving Outcomes Post Discharge
    • Table 1. Provides a quick overview of four programs currently in use for recognizing “at-risk” patients and transitioning them to some higher level of care at discharge.
    • Table 2. Offers three Primary Drivers essential in developing a post-discharge plan that can increase adherence to the plan of care.
    • Table 3. Provides an introduction to the Adherence Management or AdM Coaching process which begins at admission.
    • Table 4. A review of the AIMs, Primary, Secondary Drivers and Interventions that have been identified and shared throughout the Hospital Engagement Network. The greyed areas shows where AdM Coaching augments, replaces, or adds a specific intervention to achieve the desired drivers.
    • A detailed analysis of each of the primary drivers with interventions, tasks and measures.
  • Part 2: Looking at Human Behavior for Causative Factors
    • Behavior Basics: Bringing Out the Best in Patients
    • The Consequences of Behavior
  • Part 3: Who Owns the Behavior Change Area and What are You Going to Do About it?
  • Part 4: Consequence Management and the Adherence Improvement Plan
    • PDSA of The Consequence Analysis
  • Part 5: Measurement
    • Feedback
    • Reinforcement
  • Part 6: Conclusion and Next Steps
    • Change the Way You Work with Patients
    • No Formal Psychological Training
    • Improving the Likelihood for Success
  • Part 7: Appendices
    • I: AdM Process Map
    • II: TOP TEN CHECKLIST
    • III: Modified LACE Tool
    • IV: Transitional Care Model (TCM):
    • V: B-MAAS
    • VI: Project Boost
    • VII: B-PAAS
    • VIII: Consequence Analysis
    • IX: Adherence Improvement Plan
    • X: FUNCTIONAL ANALYSIS OF REQUIREMENTS
    • XI: The General Patient Care Team
  • Part 8: Graphics
  • Part 9: References

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