More on Reimbursement

Can measuring 'patient uncertainty' reduce readmissions?

The initiative is yielding insights that could prove valuable to any hospitals looking for ways to avoid federal reimbursement penalties.

Jeff Lagasse, Associate Editor

Plainly put, readmissions cost hospitals money. 

Patients come back to emergency rooms after their initial discharge for many reasons, but emergency medicine physician Kristin Rising, MD, sees a common theme in prior interview-based studies: patients feel uncertain. They're uncertain how to manage their symptoms, uncertain which symptoms might be a sign of disease worsening, even uncertain where to go with questions. 

To help understand, document, and find effective solutions to address this uncertainty, Rising worked with a team of Thomas Jefferson University researchers to develop a way to measure patient uncertainty, the "Uncertainty Scale," or U-Scale.

If successful, the insights could prove valuable to hospitals as they look to avoid federal reimbursement penalties. The Centers for Medicare and Medicaid Services levies such fines against hospitals for having 30-day readmissions rates higher than those of their peers.

Predicting patient needs

"We don't do a good job of predicting which patients will come back to the emergency department, which means we don't have a good understanding of why patients are coming back and how we could be assisting them in having a safer transition home from the first emergency department visit," Rising, who is director of acute care transitions and associate professor of emergency medicine at Thomas Jefferson University, said in a statement. "As a field, we've had difficulty finding an approach that consistently works to identify and address individual patient needs. The Uncertainty Scale we developed gives us a tool to help do that."

An expert in concept mapping, Marianna LaNoue, associate professor of family and community medicine and the Jefferson College of Population Health, as well as Rising and their colleagues Drs. Angela Gerolamo and Rhea Powell, spent two, six-hour days with two groups of about 20 individuals each who had recently been a patient in the emergency department. 

The patients shared ideas about what types of uncertainty people have when they are experiencing symptoms that may result in an ED visit, and then worked with the research team to map their ideas into categories. 

Common threads of uncertainty

Among the major themes to emerge from the research were concern over treatment quality, which may lead a patient to return in hopes of a second opinion, and concern about lack of a diagnosis, thus leaving a consumer with no satisfying explanation for their symptoms. 

There was also a lack of clarity regarding self-management, such that patients were unsure how to deal with symptoms at home.

Other recurrent themes included a lack of self-efficacy, manifesting as patients not knowing where to go for help for certain symptoms; lack of clarity about the decision to seek care, meaning that patients do not know which symptoms are serious enough to warrant seeing a health professional; and psychosocial factors, including worries that getting medical care might interfere with home and work commitments.

The team of researchers plans to continue to refine and validate the U-Scale itself, and plan to use it to test interventions to alleviate different categories of uncertainty.

Twitter: @JELagasse
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