Hospitals struggle to reduce readmissions for chronically ill

Registered nurse Cheryl Shelton focuses much of her work these days outside the hospital. After talking with patients before they leave, she visits them in their homes and checks in regularly by phone.

Called a "transition coach," she monitors the patient's medication schedule, offers diet and exercise recommendations, and helps the patient arrange follow-up appointments with physicians - everything it takes to ensure that he or she doesn't need a return trip to the emergency room.

Shelton plays a key role in Barnes-Jewish Hospital's latest of many efforts to tackle the vexing problem of reducing readmissions of Medicare patients. In addition to their reflection on quality of care, readmission rates have taken on a new importance for all hospitals because the federal government, under health care reform, plans to levy financial penalties on those with higher than normal readmission rates.