Hospitals are taking steps to prevent the most common risk to patients after
discharge: landing back in the hospital due to complications that could have
been prevented with better follow-up care.
A revolving door of readmissions is driving up costs for hospitals and
causing needless harm to patients, especially elderly people with multiple
chronic diseases. Nearly 18% of Medicare patients admitted to a hospital are
readmitted within 30 days of discharge, accounting for $15 billion in spending,
according to the Medicare Payment Advisory Commission, the independent federal
body that advises Congress on Medicare. As a result, readmission rates are coming
under increasing scrutiny from regulators, insurers, employers and
quality-measurement groups, who are considering methods to tie payment to lower
readmissions.
"We have to start paying attention to people's needs beyond the
hospital door," says Mary Naylor, a professor at the University of
Pennsylvania's School of Nursing. She has conducted a number of clinical trials
on a model to help older adults with complex care needs after they are
discharged. "The experience of multiple hospitalizations can take a
devastating toll on the human psyche and the quality of life for patients and
their caregivers," she says.
There are about five million readmissions a year in U.S. hospitals, with
approximately a third occurring within 90 days of discharge, according to the
Institute for Healthcare Improvement, a Boston-based nonprofit. But with
so-called transitional-care programs, which follow patients for varying periods
of time at home, as many as 46% of readmissions could be prevented, says Pat
Rutherford, an IHI vice president.
The institute is working with hospitals to reduce readmissions. Its programs
include: identifying patients at risk for return, scheduling follow-up doctor's
appointments before patients are discharged, sending nurses to patients' homes
within a few days of discharge, monitoring patients at home, and educating
patients and families on how to adhere to medication schedules and self-care
regimens. Part of the problem is that hospitals aren't paid to coordinate care
once a patient leaves. But that may change: Large managed-care groups and
insurers are now experimenting with programs to cover such services.
After patients who may be at high risk for readmission are discharged from
Kaiser's San Francisco Medical Center, nurses visit them — cutting through red
tape, if need be, to get them quickly into doctors' appointments. "We form
trusting relationships with the patient, and we know what to look for and what
could get them back in the hospital," says Jill Murray, a nurse in the
transitional-care program.
Source: Landro, Laura, “Keeping Patients from Landing Back in Hosptal,”
Wall Street Journal, December 12, 2007.