For the last three of the nearly six decades Shirley Estes, 80, has been married to her husband Harry, since his first heart attack and quadruple bypass at age 51, she has spent so many nights and early mornings in the Eastern Maine Medical Center emergency room she has lost count.
Most of the time, Shirley handled her husband's unpredictable heart health by herself. Last summer, she laid slacks and a blouse on her bed each night so she could quickly change out of her nightclothes and rush her 81-year-old, ill husband to the hospital, a few miles away in Bangor.
But last fall, following a stroke that put him in the hospital for nine days, followed by two weeks in a nursing home, Harry and Shirley Estes began receiving extra support from a new team of primary medical care providers rapidly expanding across Maine.
A "community care team" from Eastern Maine Healthcare Systems, which includes a registered nurse and physician, among others, now calls Harry Estes at least three times a week to check his medications, blood pressure, and diet while reassuring his wife that they are only a phone call away. No lines, no waiting for an appointment, and no middle-of-the-night trips to the emergency room.
Less than a year after his stroke, Harry Estes is back on his riding mower, grooming the two-acre lawn around their Brewer, Maine home. He’s also enjoying the company of his more relaxed wife, who no longer has to leave a neighbor in the house with her husband just so she can take a few minutes to go to the grocery store or run an errand.
"After his last stroke, I was going to the hospital two or three nights a week," Shirley Estes says.
"Now, anything to do with his health, I call. I don't want to be a nuisance but they tell me I'm no bother. He has not declined and he has come a long way because these people have helped me as much as it has helped him.” The improved health of Harry Estes and the additional support for his wife comes from a statewide Patient-Centered Medical Home Pilot, launched in 2010 by the Dirigo Health Agency’s Maine Quality Forum, a Maine state agency; Maine Health Management Coalition, a purchaser-led multistakeholder collaborative; and Maine Quality Counts, a regional health care collaborative funded by the Robert Wood Johnson Foundation’s Aligning Forces For Quality initiative.
In addition to improving the quality of life for patients like Harry and their families, the project has also eliminated unnecessary and expensive hospital admissions and emergency room visits from the health care system. That, supporters say, moves providers away from more costly fee-for-service reimbursement that pays no matter the outcome to more accountable payment reform pushed by private employers and insurers, as well as the Affordable Care Act.
At Eastern Maine Medical Center alone, the aggressive attention to chronic heart failure patients from registered nurse care coordinators has helped the 411-bed hospital reduce its readmission rate for Medicare patients to 12 percent last year, from nearly 20 percent just three years earlier in 2009. Such admissions can cost the health care system more than $10,000 a day, and even more depending on the severity of the illness and complexity of the patient’s condition.
Primary care practices are further supported by multidisciplinary community care teams that include nurse care managers, social workers, health coaches, and pharmacists, as well as volunteers who not only coordinate services to patients, but to families of patients like Shirley Estes as well.
"I just think this effort is going to take off," Shirley Estes says of the medical home initiative. "It just has to. It's so much better to have him back at home."