Original Article

Dramatic Reduction in 30-Day Readmissions Through High-Risk Screening and Two-Phase Interdisciplinary Care

Authors: Mabel Labrada, MD, Michael J. Mintzer, MD, Chandana Karanam, MD, Raquel Castellanos, MD, Lorinda Cruz, MD, Minh Hoang, MD, Regina Wieger, DNP, RN, Enrique Aguilar, MD, Hermes Florez, MD, Jorge G. Ruiz, MD

Abstract

Objectives: Thirty-day readmissions are common, serious, and costly. Most important, often they are preventable. The purpose of this quality improvement study was to evaluate an interdisciplinary, two-phase intervention to reduce 30-day readmissions among high-risk medical patients. One or two high-risk patients were selected each weekday by a hospitalist using literature-based, locally tested criteria that included common medical illnesses, active psychiatric illness, and recent or recurrent hospital admissions.

Methods: Patients admitted to 1 of 5 medical hospitalist teams were selected to receive the intervention; patients admitted to the 4 remaining teams were used for comparison. The two-phase care coordination intervention consisted of a daily interdisciplinary team meeting for the selected high-risk patients and postdischarge interventions that included outpatient care coordination until the patients’ first follow-up appointment. The care plan addressed medical/geriatric assessment, social stability, medication reconciliation, nutritional needs, care coordination including future appointments/testing, and community services. Eighty-five patients in the intervention group were compared with 84 patients from the comparison group using propensity score matching. Patient characteristics were similar at baseline.

Results: The intervention group demonstrated a reduction in 30-day readmissions by 52% (11 vs 23, P = 0.019). Length of stay was reduced: 5.5 days compared with 7.2 days (P = 0.258).

Conclusions: This intervention produced a significant reduction in 30-day readmissions for high-risk patients and a trend for shorter lengths of stay compared with similarly matched patients. Future research trials are needed to verify these results.

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References

1. Joynt KE, Jha AK. Thirty-day readmissions-truth and consequences. N Engl J Med 2012;366:1366-1369.
 
2. van Walraven C, Jennings A, Forster AJ. A meta-analysis of hospital 30-day avoidable readmission rates. J Eval Clin Pract 2012;18:1211-1218.
 
3. Boozary AS, Manchin J, 3rd Wicker RF. The Medicare hospital readmissions reduction program: time for reform. JAMA 2015;314:347-348.
 
4. Kansagara D, Chiovaro JC, Kagen D, et al. Transitions of Care from Hospital to Home: A Summary of Systematic Evidence Reviews and Recommendations for Transitional Care in the Veterans Health Administration. Washington, DC: Department of Veterans Affairs; 2014.
 
5. Harris LJ, Graetz I, Podila PS, et al. Characteristics of hospital and emergency care super-utilizers with multiple chronic conditions. J Emerg Med 2016;50:e203-e214.
 
6. Johnson TL, Rinehart DJ, Durfee J, et al. For many patients who use large amounts of health care services, the need is intense yet temporary. Health Aff (Millwood) 2015;34:1312-1319.
 
7. Mercer T, Bae J, Kipnes J, et al. The highest utilizers of care: individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center. J Hosp Med 2015;10:419-424.
 
8. Gon๺-Bradley DC, Lannin NA, Clemson LM, et al. Discharge planning from hospital. Cochrane Database Syst Rev 2016;1:CD000313.
 
9. van Walraven C, Dhalla IA, Bell C, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 2010;182:551-557.
 
10. Taha M, Pal A, Mahnken JD, et al. Derivation and validation of a formula to estimate risk for 30-day readmission in medical patients. Int J Qual Health Care 2014;26:271-277.
 
11. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 2011;305:675-681.
 
12. Halfon P, Eggli Y, van Melle G, et al. Measuring potentially avoidable hospital readmissions. J Clin Epidemiol 2002;55:573-587.
 
13. Marcantonio ER, McKean S, Goldfinger M, et al. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med 1999;107:13-17.
 
14. Regenstein M, Andres E. Reducing hospital readmissions among Medicaid patients: a review of the literature. Qual Manag Health Care 2014;23: 203-225.
 
15. Silverstein MD, Qin H, Mercer SQ, et al. Risk factors for 30-day hospital readmission in patients >65 years of age. Proc (Bayl Univ Med Cent) 2008;21:363-372.