As hospitals work to figure out how to reduce unplanned 30-day readmissions, a new analysis examines what some hospitals are doing.
In a new study published in JAMA Internal Medicine, the authors reviewed changes from 2010 to 2012 in the use of several commonly recommended strategies to reduce unnecessary readmissions in a national sample of hospitals participating in the Hospital to Home Quality Improvement Initiative sponsored by the American College of Cardiology and Institute of Healthcare Improvement.
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The researchers compared a baseline survey at the start of the initiative in 2010, completed by 594 participating hospitals, to a follow-up survey, completed 12 to 18 months later by 437. The surveys examined 10 practices associated with lower readmission rates, including scheduling follow-up appointments with patients before discharge, using electronic medical records to track medications, and partnering with home care agencies or physician groups for better communication and a smoother patient discharge.
There were significant changes among the hospitals for several specific strategies, said study author Leora Horwitz, assistant professor at the Yale University School of Medicine. Significantly more hospitals were partnering with other local hospitals to reduce readmissions (22.9 percent in the first survey compared to 30.7 percent in the follow-up survey), were discharging patients with a follow-up appointment already made (52.4 percent then versus 61.1 percent now), and were tracking the percentage of patients who were discharged with follow-up appointments within seven days (32.2 percent then and 43 percent now).
“The challenge with readmissions in general is we’re still not sure what works best – and not one single effort works well by itself, said Horwitz. While there isn’t a lot of evidence that one effort works better than another, all efforts, she said, work best been they are used together.
Horwitz added that while many of the hospitals involved in the study have made significant efforts when it comes to reducing readmissions, “the absolute number of hospitals in the country working on these sorts of efforts in most cases is not even half.”
“Whether hospitals take efforts in reducing readmissions in order to not get penalized or not, we should all be doing these things because it promotes quality care,” she said. “While hospitals are really taking this opportunity to improve readmissions, we’re still not all there yet.”