Perspectives
Reducing Readmission Rates by Improving Transitional Care
Abstract
Hospital readmission rates are used increasingly as a measure of healthcare systems’ overall efficacy. Improving care coordination across the continuum of healthcare delivery is crucial to reducing readmission rates. Patients with ambulatory sensitive conditions and patients without a primary care physician (PCP) often seek care in emergency departments (EDs) in lieu of an ambulatory setting, causing avoidable hospital admissions. Today, 42% of hospitalized Medicare patients have contact with a PCP within 2 weeks of hospital discharge.1 Reducing readmission rates is financially important to the US healthcare system. The Centers for Medicare & Medicaid Services estimated the cost of avoidable readmissions to be more than $17 billion annually.2 Hospitals face a payment penalty for high readmission rates, equal to 3% of their total Medicare billings.3 Successfully connecting patients with chronic illnesses to PCPs is a crucial objective for hospitals wanting to reduce readmission. This article aims to review the causes of high readmission rates, discuss solutions to avoidable utilization, and introduce the concept of a hospital-to-primary care transition clinic.This content is limited to qualifying members.
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References
1. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011;155:520-528.
2. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418-1428.
3. Goodman DC, Fisher ES, Chang CH. After hospitalization: A Dartmouth Atlas report on post-acute care for Medicare beneficiaries. http://www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf. Accessed September 11, 2015.
4. Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 2015;313:483-495.
5. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003;138:161-167.
6. Jackson CT, Trygstad TK, DeWalt DA, et al. Transitional care cut hospital readmissions for North Carolina Medicaid patients with complex chronic conditions. Health Aff (Millwood) 2013;32:1407-1415.
7. Shah R, Chen C, O’Rourke S, et al. Evaluation of care management for the uninsured. Med Care 2011;49:166-171.
8. Beresford L. Is a post-discharge clinic in your hospital’s future? http://www.the-hospitalist.org/article/is-a-post-discharge-clinic-in-your-hospitals-future/. Published December 11, 2011. Accessed July 7, 2015.
9. Doctoroff L, Nijhawan A, McNally D, et al. The characteristics and impact of a hospitalist-staffed post-discharge clinic. Am J Med 2013;126:1016.e9-e15.
10. Park HK, Branch LG, Bulat T, et al. Influence of a transitional care clinic on subsequent 30-day hospitalizations and emergency department visits in individuals discharged from a skilled nursing facility. J Am Geriatr Soc 2013;61:137-142.
11. Burns ME, Galbraith AA, Ross-Degnan D, et al. Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions. Int J Qual Health Care 2014;26:358-365.
12. Wier LM, Barrett M, Steiner C, et al. All-Cause Readmissions by Payer and Age, 2008: Statistical Brief #115. Rockville, MD: Healthcare Cost and Utilization Project, 2011.
13. Rennke S, Nguyen OK, Shoeb MH, et al. Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Ann Intern Med 2013;158:433-440.
