Rehospitalization Rate Provides Glimpse into Bigger Concerns

A study recently published in The New England Journal of Medicine shows that 20% of Medicare patients are readmitted to the hospital from which they were recently discharged within a month. That percentage jumps to 34 when looking at a three month time period. The data, representing Medicare claims collected between 2003 and 2004, show that more and more discharge is becoming a time at which it is crucial to have a good communication plan in place among caregivers and patients. What's more, the presence of a strong continuum of care can lead to lower rehospitalization rates.

"In order to address this issue, we are going to wind up addressing the most profound issues in healthcare today," says Stephen Jencks, MD, MPH, a lead author of the study and independent consultant in healthcare safety and quality. "Issues like a system which has become provider-centered rather than patient- and family-centered. If your concerns stop when the patient goes out the door of the hospital or start when the patient comes in the door of your office, you're not going to provide the care that's necessary to keep people from being rehospitalized."

Saying that rehospitalizations are costly is an understatement. In 2004, $17.4 billion was spent caring for patients readmitted to the hospital; Medicare paid hospitals $102.6 billion in total that year. Med Pac, a commission that advises Congress on Medicare policy, has recommended that instead of rewarding hospitals for the quantity of patients they see, hospitals should receive payment for providing the highest quality of care to patients—including whether their patients are readmitted with select conditions.

Some states are already performing far better than others in terms of rates of rehospitalization. The five states with the highest rates of rehospitalization have rates 45% higher than the 5 states with the lowest rates of rehospitalization. What this shows, is the degree to which the community at large is a player, or what Jencks describes as a two-way street, and not simply the fault of the hospital.

"The way to see this is as a community challenge—to get people, whether they are hospital CEOs, nursing home managers, mayors, or the directors of the health departments—to be thinking about how their role involves bringing people together," says Jencks. "For a hospital, it's a wonderful opportunity for them to take a leadership position which will ultimately benefit them."

So how can hospitals do their best to prevent readmissions?

• Ensure that a member of the patient's family, or a caregiver, will be present at discharge and a part of the care planning process. "The patient is rarely going to be able to take this responsibility in the shape that their usually in when they're discharged," says Jencks.
• Using the teach-back method, a style which asks patients to repeat back to the explaining caregiver in his or her own words the information exchanged, teach patients and families what they will need to do to care for themselves at their next phase of care, what the risks are that warrants a phone call to a physician, and a phone number that they can call when one of those risks arise.
• Prevent the patient from leaving the hospital without a follow-up appointment of some kind. In his study, Jencks and his colleagues found that about 50% of patients who were rehospitalized had not been seen by an interim physician after 30 days. Hospitals often say that they can't make an appointment in that short of a timeframe for a patient's follow-up care, says Jenks. "My answer is, well if you can't get it how do you think the patient's going to get it?"
• Create a list of reconciled medications for the patient to take with him or her at discharge that clearly spells out what he or she should be taking upon leaving the hospital. Many patients go home and stare into their medicine cabinets, confused about those medications that they took before being hospitalized.