At a health system in Indianapolis, a dashboard launched before the coronavirus pandemic has taken on a new focus in recent months.
In October, Indiana University Health started a pilot project aimed at better understanding what happens to patients discharged to post-acute providers, said Dr. Anthony Sorkin, executive medical director of population health at IU Health. That “feels like it was a hundred years ago.”
In the six months since, COVID-19 has wreaked havoc, with more than 1 million cases and 60,000 deaths in the U.S. alone, according to the Johns Hopkins Coronavirus Resource Center.
IU Health’s initiative rolled out a dashboard to three of the system’s hospitals and about two dozen nearby nursing homes so nurses could send progress updates on shared Medicare Advantage patients. From there, IU Health planned to assess whether receiving daily notes would lead to a lower hospital readmission rate and nursing home length of stay.
The pilot was designed to bolster the more traditional, but time-intensive, processes of hospital staff calling or even visiting a nursing home in person to check on a shared patient.
In the wake of COVID-19, IU Health added all its hospitals to the dashboard app and opened participation to the more than 300 nursing homes in Indiana—nearly 200 of which are now using the dashboard—and revamped the program so nurses answer five questions about shared patients’ COVID-19 symptoms daily, regardless of insurance type.
In Indiana, most COVID-19 cases—around 65%—are among those under age 60, but 90% of deaths are people age 60 or above, according to data from the state health department. Officials last week said nursing homes account for nearly one-third of the state’s COVID-19 deaths.
COVID-19 outbreaks at nursing homes have taken place across the U.S., but to date it’s unclear how many deaths have happened at the facilities nationwide. That may change soon, as the Trump administration in late April mandated that nursing homes report cases of COVID-19 directly to the Centers for Disease Control and Prevention.
For IU Health, having daily updates on symptoms related to COVID-19 helps hospital staff determine whether those cases can be treated remotely. Sorkin said having a log of patients’ symptoms over time helps to triage them based on how their condition has changed.
Through the dashboard, bedside nurses can also notify physicians at IU Health when they have a question or think a patient’s care needs to be escalated. That has helped teams to better coordinate care, even when nursing homes have locked down and stopped admitting visitors, including other healthcare providers.
Reaching out to IU Health physicians through that process has helped to get the guidance and support needed to treat patients in place in the nursing home when possible, and subsequently avoid unnecessary transfers to emergency departments, said Troy Reiff, vice president of post-acute service development and managed care at American Senior Communities.
Thirty-one of American Senior Communities’ facilities are linked with IU Health hospitals through the dashboard.
“You have to have physicians on the other side,” Reiff said. “You can have the software all day, but for this to really work at its maximum potential you need a strong physician group.”
IU Health said it couldn’t disclose terms of its contract with Olio, the Indiana-based healthcare software startup that developed the dashboard. Olio said the software is a subscription service for hospitals, but free for post-acute care facilities.
Regular communication between hospitals and nursing homes is particularly helpful for a disease like COVID-19, according to Alice Bonner, senior adviser for aging at the Institute for Healthcare Improvement.
“COVID-19 is a new type of virus,” she said. “People’s conditions can change rapidly and unpredictably.”
Setting up a quick way to communicate is not only important for physicians to be able to provide nursing homes with guidance into how to care for and monitor possible COVID-19 patients in place, but also to make sure bedside nurses can alert hospitals about a possible COVID-19 transfer coming their way if a patient’s symptoms start to worsen.
Bonner highlighted that providers across the healthcare continuum should keep in mind that seniors might display different COVID-19 symptoms than the general population.
“Some older adults may not get a fever,” she said. Instead, they might display symptoms like nausea, dehydration and confusion.