Biting the All-Cause Readmissions Bullet
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The Blue Ridge group also tracked all-cause readmissions across its two hospitals. One of them, 184-bed Grace Hospital in Morganton, N.C., saw an improvement in its expected all-cause readmission rates and its observed rate. For example, by 2012, its expected all-cause rate was 10.13%, but the hospital actually saw only 6.35% of its patients return within 30 days, says Maxine Molter, Blue Ridge HealthCare's vice president of medical management.
Primary care physicians on staff at 241-bed Cleveland Regional Medical Center in Shelby, N.C., meet regularly with hospitalists to work out problems. There are plans to ensure that when any patient is discharged, hospitalists check that a follow-up physician appointment has been made and that a discharge summary is created "with urgent follow-up needs at the top," Neuwirth says. Any readmission that happens in spite of these efforts will be reviewed jointly by the hospitalist and the patient's primary care physician to see what went wrong.
The fact that they've "agreed to do this together, across the chasm of the hospital-ambulatory care divide, is huge," Neuwirth says.
Holyoke (Mass.) Medical Center, a 198-bed facility, has an underserved patient mix that includes some of the most socioeconomically disadvantaged in Massachusetts, says Jim Keefe, vice president of inpatient services. With the hiring of two people devoted specifically to the effort, the hospital has had success in reducing 30-day all-cause readmissions.
In January, February, and March of 2011, for example, readmission rates were 13.5%, 14% and 22%, respectively. But in the last three months of 2012, they had dropped to 12.7%, 9.2% and 12.1%, with better health for patients with chronic obstructive pulmonary disease, one of the key targets.
"We realized that the only way to reduce our all-cause readmission rate was to hit every single patient," says Cherelyn Roberts, RN, BSN, program manager for the Holyoke STAAR initiative (STate Action on Avoidable Rehospitalizations), a readmission tool designed by the Institute for Healthcare Improvement. "We started with heart failure, but then took on COPD," because Holyoke's catchment area includes a lot of smokers.
"We interviewed some of our patients who were being frequently readmitted and discovered that many patients had never touched an inhaler. They were given a piece of paper and told to go to a pharmacy and get it, and then they were on their own. No one ever watched them effectively administer it."
Now the patients receive extensive teach-back for multiple days before their discharge with the same type of inhaler they're prescribed so they'll know what to do when they leave.
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