Grand-Aides USA Summary
- The goal of Grand-Aides USA ® is to improve population health and provide appropriate access to care while reducing unnecessary emergency, clinic and hospital visits in adults and children, thus reducing costs: one person at a time. Grand-Aides USA provides an innovative health care delivery program with caring, experienced nurse extenders making home visits to develop a trusting relationship, connecting the patient and care team quickly and cost-effectively. Please see the most recent article in American Journal of Cardiology. Please see short video on Grand-Aides.
- Grand-Aides, regardless of age, have the temperaments and
personalities of a good grandparent. Grand-Aides have had prior training in
medical care (such as a Nurse Aide or community health worker) and then take an
added Grand-Aides curriculum. They are generally paid. Under close supervision
by a nurse or physician, Grand-Aides use telephone protocols and home visits
with portable telemedicine; they provide transitional – hospital discharge –
and chronic disease management, as well as primary and preventive intervention
to improve access to needed care and reduce unnecessary emergency, clinic and
hospital visits, reducing costs. Grand-Aides are known by patients and families
as trusted partners that assist in improving their health one step closer to
home. Grand-Aides programs are in operation or under discussion in over 50 US sites
and 14 international locations.
- Grand-Aides USA has 2 employment models: 1. Grand-Aides USA employs Grand-Aides and supervisors; 2. Grand-Aides USA trains local supervisors who then train the local Grand-Aides.They can be employed either by the hospital / health system or a home health agency.
- Grand-Aides address the following issues in both adults and children: 1. Improved management of chronic disease, to keep patients as healthy as possible and out of the hospital: readmissions - improving care transitions and reducing unnecessary admissions; 2. Overcrowding in busy clinics and Emergency Departments with hyper-utilizers; 3. Improved access to care in rural areas for those who have little or none.
Grand-Aides programs are flexible to the needs of the patients.
- Care Transitions/Chronic Disease Care aimed at improvement in health, management of chronic disease, and reduction in resource utilization (e.g. hospital readmissions) for such conditions in adults as cardiac disease (heart failure , acute myocardial infarction, post coronary bypass and post percutaneous coronary intervention), Chronic Obstructive Pulmonary Disease, Diabetes and others; in children, those with medically-complex conditions (in partnership with the Children's Hospital Association), and other children with single chronic diseases such as such as asthma. In both adults and children, Grand-Aides visit every day for the first 5 days after hospitalization, less the next week and then according to the needs as determined by the supervisor. They complete personalized symptom questionnaires, send the answers electronically to the supervisor and then the supervisor then goes on video with the patient. The Grand-Aides teach extensively specifically about discharge instructions with numerous approaches to medication adherence and prevention.
Data: The American Journal of Cardiology: Effect of Grand-Aides nurse extenders on readmissions and emergency department visits in Medicare patients with heart failure. shows the following:
At the University of Virginia, outcomes were recorded for patients with heart failure: 108 with GA and 854 controls.
- GA patients had 2.8% 30-day all-cause readmissions vs 15.8% in the controls -- an 82% reduction (aOR=0.17; p=0.0060); 6-month all-cause readmissions 13.0% vs 44.7% (aOR=0.19; p<0.0001); Emergency Department 30-days of 2.8% vs 45.1% (aOR=0.03; p<0.0001); ED 6-months 12.0% vs 51.5% (aOR=0.09; p<0.0001); GA mortality within 6 months was 2.8% vs 7.7% (aOR=0.37; p=0.1141).
- Length of stay decreased from 9.0 to 6.2 days (p<0.0001)
- At 30 days, 92% of GA patients had “substantial medication adherence.”
- Net savings per GA was $562,097, a 7X return on investment. This represents the best data in 5 years when compared with other published programs to decrease readmissions. Similar results have been obtained at the Cleveland Clinic, Temple University and Houston Methodist Hospital
- Primary care. Grand-Aides function as a part of a primary care team, e.g. a "Patient Centered Medical Home" to help care for adults and children. Grand-Aides first meet the patient / family in the clinic. When a member of one of these families calls, the Grand-Aide asks a series of questions in a "protocol" (or questionnaire) for one or more of 20 conditions (e.g. cold, fever). The Grand-Aide receives instructions from the supervisor, and may involve a home visit by the Grand-Aide. They also make home visits for primary prevention – and efficiency (e.g. reduce "no-shows") as well as secondary prevention – and “intervention” with intense attention to medication adherence (e.g. for asymptomatic patients with hypertension). In the article in Health Affairs on primary care: 62% of drop-in acute care clinic visits could have been potentially cared for by a Grand-Aide and Nurse Supervisor and 74% of Emergency Department visits fit one of the 20+ Grand-Aides protocols.
- Population-based programs. Each Grand-Aide may be trained to do more than one of these programs and approach entire populations rather than by disease. There are also programs for entire populations such as Medicare, Medicaid, and ACO’s. We also have programs aimed at sub-populations such as the frail elderly with chronic disease, as well as secondary prevention to improve adherence with the medical regimen and diet in hypertension, diabetes and obesity.
- Rural Care Delivery. Grand-Aides meet patients in the hospital or clinic and ideally make at least one or two home visits, regardless of the distance to see the home environment, meet families and understand the home conditions. The Grand-Aide then makes sure the patient has a method to do video and understands the use – either dedicated television camera, tablet or smart phone. If the family does not have this, it will be an expense to the program. If it is absolutely not practical to make even an initial home visit, then the “bonding” of the patient and family with the Grand-Aide must occur entirely in the clinic or hospital.
- Grand-Aides USA programs Grand-Aides USA has programs in various settings: Integrated systems, Academic health centers, ACO's, Hospital systems, Mental health hospitals, Medicaid HMO's, Community hospitals, Physician groups, Home health agencies, Visiting Nurse Associations, Indian Health Service, Rural Health, Medicare Advantage, Commercial Insurers, FQHC's, Medicaid, Professional societies.
- THE AMERICAN HEART ASSOCIATION HAS RECENTLY AWARDED GRAND-AIDES WITH TWO NATIONAL QUALITY AWARDS; GRAND-AIDES HAS PREVIOUSLY BEEN NAMED A "TOP-3" INNOVATOR BY THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY