On Accountable Care – Data or Patients, Which Should Come First?

I saw an article on this today – the answer is a no-brainer.

Patient first, data needed for decision-making at the patient level, then other data, in that order.

Aside from all of the mandated data collection, internal healthcare facility need for data and information needed to make bedside decisions, we should never lose focus on the fact that the patient wants out as soon as practicable,  with the proviso of no near-term relapse/return.

Does this not tell us that the Case level focus from the time the pt presents should be on discharge planning? (pt gets to go home, beds become available, providers are able to focus on other pts).

The problem of course is that each pt is unique in terms of when they can/should be discharged.

So, we clearly need at the Case level a non-subjective in-your-face means of tracking progress toward pre-defined discharge objectives (this pt can be discharged because they are in a residence with a 24 x 7 nurse for emergency contact purposes, this pt can go home because they have access to a visiting nurse, this one because they have a caregiver, NOT this one because they live alone and have no support system)

When setting up a set of discharge objectives, some related, some not, it is NOT always essential that all get met, or that all of a short list of pre-defined objectives get met.

The right approach is Cases get closed when Case Managers close them, not when some algorithm posts a discharge advisory.

The Rand Corporation figured out how to manage conflicting needs back in the 1960s.

Adapting this from their application area (missile range, accuracy, payload) to healthcare discharge planning required a bit of out-of-the-box thinking but my group now promotes FOMM (Figure of Merit Matrix) as a default form (spreadsheet actually) at patient Cases.

Want to start using FOMM?  No need for anything other than the ability to attach a default on load spreadsheet to your EHR.

You can have FOMM working for you by the end of any working day.

Read all about FOMM at



About kwkeirstead@civerex.com

Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2019 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Case Management, Decision Making, Discharge Planning, Uncategorized and tagged , . Bookmark the permalink.

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