All Entries Tagged With: "readmission"
Readmissions reduction program to be adopted by hundreds of others
Reducing readmissions is certainly on the forefront of the future of healthcare. Through Partnership for Patients, we know the government is working to reduce hospital readmissions by 20% by 2013 by granting up to $500,000 toward the effort.
We also know that The Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) proposed rule would establish a new hospital readmission reduction program, under which hospitals with excessive readmissions within a 30-day period would receive reduced payments. The proposed rule applies to discharges after October 1, 2012 and applicable conditions include myocardial infarction, heart failure, and pneumonia—based on the current inpatient quality reporting measures.
So the ducks are in a row and now the work begins. A few years ago, in the June 2009 issue of Briefings on Patient Safety (now Patient Safety Monitor Journal), we explored a program called Project RED (Re-Engineered Discharge), which has actually been evolving since 2003 (according to a timeline on its website). The program now involves a thorough discharge process and allows patients to use a virtual education program (a computer-animated “Nurse Louise”) to better understand their discharge plan.
Joint Commission Resources has received funding from the Agency for Healthcare Research and Quality to help 250 hospitals adopt Project RED, which helped cut readmission at Boston University Medical Center by 30% in a 2008 study, reports the Wall Street Journal, which has has posted two separate blogs on readmissions, found here and here.
Hospitals can currently download tools from Project RED by visiting the website.
Patient discharge planning receiving more attention
Discharge planning has been an often neglected time in a patient’s hospital stay, which is likely one of the main reasons 20% of patients return to the hospital within 30 days, reports The New York Times. Several new programs have taken root to reverse this trend and ensure that patient care at discharge is a focal point to prevent patients from returning to the hospital.
Two of these programs, Project BOOST (Better Outcomes for Older adults through Safe Transitions) and Care Transitions Intervention, are leading the way. Project BOOST is a creation of the Society for Hospital Medicine and provides interested hospitals with a toolkit of standardized forms to streamline the discharge process. Care Transitions Intervention is out of the University of Colorado Denver’s School of Medicine, with funding from the John A. Hartford Foundation and the Robert Wood Johnson Foundation.
I wrote about the Care Transition Intervention program a couple of years ago in Briefings on Patient Safety. At that time, this project was a newer take on how to manage the handoff process for patients being discharged from the hospital. It also gave rise to the notion of a “transitions coach,” a similar concept to that of the “patient navigator” I posted about last week.
Has your facility taken part in any program that focuses on patient discharge as a means of preventing rehospitalization?
AHRQ releases software to help hospitals analyze and publicize quality data
Last Friday the Agency for Healthcare Research and Quality (AHRQ) announced it had created a new data analysis software tool for hospitals to use. The Windows-based tool, called MONAHRQ (My Own Network, Powered by the AHRQ) will help facilities better aggregate, analyze, and display quality data–and it’s all free! The tool also allows users to create Web sites that display the data for internal benchmarking use or to showcase quality of care statistics to the public.
Hospitals that are already using many of the AHRQ’s quality indicators, reporting template, and more, can easily use that data to plug into the MONAHRQ software tool. Additionally, the AHRQ has said that the data that can be captured by MONAHRQ goes beyond that of the Hospital Compare tool with some of the information available, such as hospital-specific data on patient safety events and deaths, as well as preventable rehospitalizations.
I’m hoping to find out more about this tool in the coming weeks, but it sounds like an exciting development, especially for hospitals that do not otherwise have the resources to create an informational website like this for their community to view.
Canadian research team develops moniker to predict if patients will die or be readmitted after trip to ED
A new tool developed by a Canadian research team could help hospitals and physicians determine a head of time which patients may be readmitted or die in the 30 days after being admitted to the emergency department. CTV News reported on a study appearing recently in the Canadian Medical Association Journal that surveyed nearly 5,000 patients at 11 Ontario hospitals. The researchers developed the following acronym to help physicians evaluate a patient’s risk of readmission or death:
L — Length of stay (Longer hospital stays equal greater risk for a bad outcome postdischarge)
A — Acuity of the admission
C — Comorbidity
E — Emergency Room Visits (the higher number in the prior six months, the worse)
By calling patients who had been discharged from the emergency department, researchers found that 8% of patients had either died or been readmitted to the hospital within 30 days (9.4% had died, while 90.6% were readmitted). By examining the characteristics of these patients, the researchers were able to develop this tool.
HealthLeaders Media publishes list of 20 people who make healthcare better
HealthLeaders Media publishes an annual list of 20 people who make healthcare better. This year’s list runs the gamut of healthcare executives, healthcare insurance staff, patients and consumers, and nurses and physicians who have gone above and beyond to improve healthcare. If you have time, check out the entire list.
I want to bring attention to one person on the list, Brian Jack, who was in charge of a research grant called Project RED, which stands for re-engineered discharge. We covered the project back in June 2009 in a Briefings on Patient Safety article. Jack and his team received a grant from the AHRQ to study where errors were occurring in the discharge process–not so much during discharge but after discharge, when 30% of patients are readmitted to the hospital. Project RED utilizes 11 interventions in a checklist at a patient’s discharge to make sure the patient understands his or her discharge instructions. Another key component is ensuring patients have a follow-up appointment booked within 24 hours. Hopefully this project, and others that emphasize the need to spend more time with patients during the crucial discharge process, will help reduce readmission rates.
Preventing Rehospitalizations audio conference on Monday!
Thought I’d highlight a fantastic program HCPro is offering next Monday from 1pm-2:30pm. The audio conference, titled Preventing Rehospitalizations: Engage Your Hospital and Healthcare Community, features two knowledgeable speakers.
Amy E. Boutwell, MD, MPP, director of strategic improvement policy for the Institute for Healthcare Improvement (IHI) will lead off the audio conference discussing the many factors that contribute to high rates of rehospitalization, some ongoing projects that have been working to reduce the number of readmitted patients, and the IHI’s recently launched STAAR initiative, which stands for STate Action on Avoidable Rehospitalizations. The second speaker, Margaret Namie, RN, BSN, MPH, CPHQ, vice president of quality at Mercy Health Partners of Southwest Ohio, will share her insights into creating a program for preventing rehospitalizations in heart failure patients.
I hope you consider listening in, it is going to be a great audio conference.
For more information, or to register for the audio conference, click here.
Reducing rehospitalizations proves to be difficult and costly
Reducing rehospitalizations has become a national focus as health reform plays out. Readmissions are an easy target because they cost the nation’s health system a lot and are often preventable. The Wall Street Journal, however, reports that many facilities that focus on preventing readmissions have often run out of funding for such programs because while the strategies may work, they are not reimbursed by any major health plan or the federal government.
Additionally, hospitals are learning that preventing rehospitalization, especially for patients with specific diagnoses, is as much a matter of quality care in the hospital as it is encouraging patients to focus on healthy strategies once they have been discharged. This seemed like one of the more exasperating points in the article. Hospitals are having to take accountability for poor coordination of care services once a patient has been discharged. Many patients enjoy their (sometimes unhealthy) lifestyles and may revert back to them regardless of care systems in place.
Some of the proposals for health reform include penalizing hospitals with poor rehospitalization rates. One proposal calls out withholding reimbursement for rehospitalized patients who suffered from a heart attack, heart failure, or pneumonia. Another proposal would penalize hospitals in the top quartile for readmissions of specific conditions.
Has your facility found success with any particular programs to prevent rehospitalization? If so, have you also seen a cost savings associated with that program?
Patient safety-related cost savings not always easy to calculate
As hospitals face deeper payment cuts from the federal government, many are considering new methods to cut costs. Indeed, many hospitals have already cut staff members and scaled back existing expansion projects. President Obama has suggested penalizing hospitals for poor rehospitalization rates—those facilities that have higher rates of patients returning for care once they have been discharged.
Unsurprisingly, patient safety officers and quality improvement managers have had to talk the business talk more often this year, often being asked to make a sound financial argument for new quality initiatives.
However, calculating savings from newly implemented quality initiatives or staying the course with sound evidence-based practice is not always easy. This article from American Medical News highlights some ways that hospitals are struggling to quantify any savings they have seen. It’s true that taking part in the important quality projects often does save costs on some end, but that money might not directly go to the bottom line. Click here to read more from American Medical News.
Have you had to “quantify” any patient safety or quality initiatives this year that you or your department has taken part in?
Hospital Compare Web site adds new readmission data
Yesterday the Hospital Quality Alliance announced the addition of new data available on the CMS Hospital Compare Web site. The general public, as well as the medical field, can now log on and compare hospital readmission rates for Medicare patients suffering from a heart attack, heart failure, and pneumonia. The data show readmissions within 30 days of discharge from any facility, even if patients do not return to the hospital from which they originally were cared for. This data, collected from Medicare billing records from July 2005 through June 2008, will provide consumers the ability to make a more educated decision about where they want to seek care.
Readmission rates have become a focus of many prominent groups of late. A study published in the New England Journal of Medicine earlier this year revealed that 20% of Medicare patients are readmitted to the hospital within a month of being discharged, and 34% are readmitted within three months (see an earlier blog post on this announcement). The CMS launched a pilot project earlier this year to reduce readmissions by working with 14 Quality Improvement Organizations (QIO). The IHI has launched an initiative called STAAR, which stands for State Action on Avoidable Rehospitalizations.
Additionally, the Obama administration is eyeing rehospitalizations as something that could be financially penalized. Rehospitalizations represent a significant amount of money spent (an extra $17.4 billion in 2004) and an example of how the current health system fails at treating patients in all areas of life and paying particular attention to transitions in care.
Those who log on will find that hospitals’ readmission rates for the conditions listed above are rated as “no different than the U.S. national rate,” “better than the U.S. national rate” or “worse than the U.S. national rate”. Users then have the option to view specific percentages in graphs and tables for the hospitals they have selected to compare.
“”America’s hospitals have long been committed to improving patient care and welcome the
opportunity to use all of the information on the Hospital Compare Web site to gain new insights
into how to strengthen quality,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “In particular, the new information on readmission rates gives hospitals a broad look at how their patients receive care both inside a hospital and after they have been discharged. With the new information now in hand, hospitals will seek to understand why patients are readmitted and how some of those readmissions can be prevented through appropriate changes in care delivery.”
Any reaction to this latest release of quality information on the Hospital Compare Web site?
New study shows fewer patients see primary care doc while in hospital
A study published in today’s Journal of the American Medical Association highlights another interesting point about the continuum of care. I posted twice in the past couple of weeks about reducing rehospitalizations, (last week the CMS announced a pilot project to reduce readmissions) and often one indicator that a patient will avoid rehospitalization is if he or she already has a follow-up appointment booked with a primary care physician (PCP), or specialist after being discharged.
The new study shows that hospitalized Medicare patients age 66 and older are less often being visited by a PCP or other doctor with whom they have been in contact during the past year while during their hospital stays. The study examined enrollment and data claims and found that in 1996, 50.5% of patients in this age group were seen by at least one doctor with whom they’d had some contact with in the last year during a hospital stay. That percentage dropped to 39.8% in 2006. A similar trend occurs when looking specifically at visits by a PCP: in 1996 44.3 % of patients were visited by their PCP during a hospital stay and in 2006, only 31.9% were.
The authors of the study intended to examine the role of the continuum of care plays in keeping patients age 66 and older healthy. One reason for this decrease in visits by a PCP or specialist is the increase in the number of hospitalists that are present in hospitals today. Hospitalists often orchestrate a patient’s care while he or she is inside the hospital and may do some of the tasks that PCPs do when they visit a patient in the hospital.
