MD Conference Express ATS 2013 - (Page 10)
FEATURE
Hospital Readmissions:
Challenges and Opportunities
Written by Maria Vinall
Hospital readmissions are frequent (~20% of patients
admitted to the hospital are readmitted within 30 days of
discharge) and expensive (~$12 billion dollars/year). The
Medicare Payment Advisory Committee has estimated
that about 13.3% of these readmissions are preventable
[Medicare Payment Advisory Commission. Medicare
Payment Policy 2007]. The objective of the Hospital
Readmissions Reduction Program (HRRP) is to reduce
the rate of rehospitalization of Medicare patients for acute
myocardial infarction (AMI), congestive heart failure
(CHF), and pneumonia, and beginning in 2014, chronic
obstructive pulmonary disease (COPD).
There does not appear to be any specific intervention
or bundle of interventions that will reliably reduce
rehospitalization [Hansen LO et al. Ann Intern Med 2011].
David H. Au, MD, MS, University of Washington, Seattle,
Washington, USA, said that reduction in rehospitalization
must account for hospital and individual components, and
the delivery and quality of outpatient care. Advanced care
planning, continuity of follow-up, and access must also be
considered (Table 1). He suggested that reducing hospital
readmissions is an outcome of good health, so the most
appropriate approach is to focus on improving health as a
social issue as well as a hospital goal. To accomplish this
we need to redesign and coordinate how the stakeholders
interact [Kangovi S et al. JAMA 2011].
Table 1. Conceptual Model
Community
Medication safety
Availability, timeliness, clarity and organization of information
Complete communication of information
Hospital
10
July 2013
Ideal Transition in Care
Conceptual Model
Educating patients to promote self-management
On Admission
■ Caregivers and social support circle for patient
■ Functional status evaluation
■ Cognitive status
■ Abuse/neglect
■ Substance abuse/dependence
■ Plans for care—palliative or restorative?
Near Discharge
■ Functional status evaluation
■ Cognitive status
■ Ability to obtain medications
■ Identify party responsible for ensuring medication adherence (if not patient)
■ Home preparation for patient’s arrival (eg, medical equipment, safety
evaluation, food)
■ Financial resources
■ Transportation to home
■ Access (eg, keys) to home
■ Support circle for patient
■ Understanding of diagnosis, treatment, prognosis, follow-up, and
postdischarge warning signs and symptoms (confirmed with teach back)
■ Transportation to home (or skilled nursing facility) and initial follow-up
■ Contact information for home caregivers to patient
Monitoring and managing symptoms after discharge
Educating patients to promote community supports
Table 2. Safe Transition Planning
At Discharge
Outpatient follow-up
Coordinating care among team members
Jerry A. Krishnan, MD, PhD, University of Illinois
Hospital and Health Sciences System, Chicago, Illinois,
USA, discussed Project BOOST (Better Outcomes for Older
Adults Through Safe Transitions) as an example of one
initiative that is striving to improve the care of patients as
they transition from hospital to home.
There are factors during the index hospitalization that
can be addressed to reduce readmissions. Table 2 lists some
of the concerns/evaluations that are addressed at each
phase of the initial hospital stay as part of Project BOOST’s
General Assessment of Preparedness. The objective is to
identify patients at risk for readmission, target interventions
to avoid readmission, and improve the information flow
between inpatient and outpatient providers.
Source: http://www.hospitalmedicine.org/
A successful transition program requires careful
planning and implementation and a process for ongoing
monitoring and adjustment (Table 3). Development of
the program should include the healthcare workers who
interact with patients at all stages of their hospitalization
and the staff of the facilities to which patients will transition.
The development team should also include nutrition
and dietary specialists, medical records technicians, and
hospital data specialists and should consider the needs
of the individuals who will be supporting the patient
postdischarge. Dr. Krishnan suggested that input from
former patients might also help to enhance the process.
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http://www.hospitalmedicine.org/
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Table of Contents for the Digital Edition of MD Conference Express ATS 2013
MD Conference Express ATS 2013
Contents
Prevention and Early Treatment of Acute Lung Injury
Nocturnal Noninvasive Ventilation Improves Outcomes in Multiple Disorders
Hospital Readmissions: Challenges and Opportunities
EBUS-TBNA: Accurate and Safe for Detecting Sarcoidosis
Data Link Obstructive Sleep Apnea and Type 2 Diabetes
Statin Use Improves Respiratory-Related Mortality in Patients With COPD
Addition of Spironolactone to Ambrisentan May Be a Novel Treatment Strategy to Improve Outcome in Patients With PAH
Haloperidol Does Not Prevent Delirium in Ventilated ICU Patients
Beraprost Plus Sildenafil Effective in Pulmonary Arterial Hypertension
Dupilumab Is Safe and Effective for Controlling Asthma Attacks
Once-Daily QVA149 Improves Breathlessness in COPD Patients
CPAP in CVD and OSA Does Not Significantly Improve Cardiovascular Biomarkers
CPAP Reduces BP in Patients With Resistant Hypertension and Obstructive Sleep Apnea
Effects of Obesity on COPD
Pulmonary Embolism
Ventilator-Associated Pneumonia
Lung Cancer Screening
Idiopathic Pulmonary Fibrosis
Non-Small-Cell Lung Cancer
MD Conference Express ATS 2013
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