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.