Potentially avoidable readmissions: Understanding drivers and
technology-enabled solutions

Background: Readmissions for ACS are common, costly, and potentially preventable. According to Medicare 13.4% of AMI admissions were followed by a rehospitalization within 15 days. A 2007 MedPAC report declared 76% of 30-day readmissions preventable. These rates are used as quality indicators despite lack of consensus on the definition of avoidable and unavoidable readmissions. We sought to define these terms and to analyze the effect of these definitions on 30-day outcomes. Methods: BRIDGE (Bridging the Discharge Gap Effectively) is an NP-led transitional care program for cardiac patients within 14 days of discharge. Retrospective data were abstracted on ACS patients readmitted before their appointments between 2008-2010. All readmissions were characterized as avoidable or unavoidable. Definitions were developed from the literature and in concert with senior cardiologists. Avoidable readmission was defined as being the result of a patient or provider issue that if managed may have prevented the admission. Unavoidable readmissions were defined as a patient in need of acute care. Avoidability status was further divided as related or unrelated to the index diagnosis. Results: Of 1188 BRIDGE referrals 304 (25.6%) experienced ACS events. In comparison to the total ACS population, patients readmitted before their BRIDGE clinic appointment (BC) (n=21, 6.9%) tended to be older, female, and were less likely to have a history of a cath or AMI (Table 1). In this study, 81% (n=17) of early readmissions were deemed unavoidable and most (n=14, 66.7%) were attributed to non-ACS issues or disease progression. These unavoidable readmissions included patients with cancer complications, chest pain, or other non-related diagnoses. Only 19% (n=4) of the readmissions were declared avoidable as a result of patient lack of adherence or provider issues such as adverse drug effects. Conclusion: The majority of early (before BC) readmissions following an index hospitalization for ACS patients referred to BRIDGE were unavoidable and unrelated to ACS. A clear discrepancy is seen between the 76% preventable readmissions in the MedPAC report and the 19% preventable readmissions in this study. Distinctions between unavoidable and avoidable readmissions should inform the utility of 30-day readmission rates as quality metrics.

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Financial impact of introducing the Swiss-DRG reimbursement system on potentially avoidable readmissions at a university hospital

Swiss Medical Weekly ◽

10.4414/smw.2015.14097 ◽

2015 ◽

Cited By ~ 2

Author(s):

JB Wasserfallen ◽

J Zufferey

Keyword(s):

Financial Impact ◽

University Hospital ◽

Reimbursement System ◽

Avoidable Readmissions

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Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

Journal of Neurosurgery ◽

10.3171/2018.2.jns172962 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1692-1698 ◽

Cited By ~ 1

Author(s):

Mitchell P. Wilson ◽

Andrew S. Jack ◽

Andrew Nataraj ◽

Michael Chow

Keyword(s):

Multivariate Analysis ◽

Quality Of Care ◽

Readmission Rate ◽

Univariate Analysis ◽

Surrogate Marker ◽

Readmission Rates ◽

Factors Associated ◽

Neurosurgical Patients ◽

Avoidable Readmissions

OBJECTIVEReadmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.METHODSA retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions.RESULTSA total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4–5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4–5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3–4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3–0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4–22.8).CONCLUSIONSAlmost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessing predictors of avoidable readmissions is warranted.

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Assessment of Avoidable Readmissions in a Visceral Surgery Department with an Algorithm: Methodology, Analysis and Measures for Improvement

World Journal of Surgery ◽

10.1007/s00268-018-4755-y ◽

2018 ◽

Vol 43 (1) ◽

pp. 107-116 ◽

Cited By ~ 1

Author(s):

Fabio Agri ◽

Anne-Claude Griesser ◽

Estelle Lécureux ◽

Pierre Allemann ◽

Markus Schäfer ◽

...

Keyword(s):

Visceral Surgery ◽

Surgery Department ◽

Avoidable Readmissions

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Transition of Care for Discharged Patients

10.46409/sr.jlok5085 ◽

2020 ◽

Author(s):

◽

Rolando Ramos

Keyword(s):

Readmission Rate ◽

Transitional Care ◽

Care Practice ◽

Evidence Based ◽

Transition Of Care ◽

Practice Problem ◽

Clinically Significant ◽

High Readmission Rate ◽

Hospital To Home ◽

Avoidable Readmissions

Practice Problem: The 30-day readmission rate for patients discharged from the hospital and returned to their primary care in a clinical office setting (21%) was higher than the national average readmission rate (17%). The high readmission rate suggested patients were receiving transitional care that was fragmented and non-standardized. Therefore, the implementation of a collaborative transition of care practice was vital to reduce avoidable readmissions. PICOT: The PICOT question that guided this project was, “In adult patients with chronic conditions, what is the effect of a transition of care practice, versus a non-standardized practice, on reducing 30-day readmissions, within a 30-day period?” Evidence: Evidence suggests that implementing a multidisciplinary Transition of Care practice for patients who are discharged from the hospital to home decreases the 30-day readmission rate. Intervention: Using a multidisciplinary approach, the registered nurse implemented a Transition of Care practice, consisting of 10 evidence-based interventions, applied to help the patient transition from hospital to home. Outcome: The results of this project revealed a decrease in the 30-day readmission rate from 23% to 15%. Also, seven of the 10 interventions were successfully implemented at a rate of higher than 85%. Conclusion: The reduction in the percent of 30-day readmissions was statistically and clinically significant between the pre-transition of care and the post-transition of care participants. In addition, the transition of care interventions were successfully implemented to standardize an evidence-based practice for patients transitioning from the hospital to their home.

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Characterization of Readmissions Among Patients Enrolled in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program Over a 2-Year Period at UNC Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.795 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S335-S335

Author(s):

Onyeka Nwankwo ◽

Anh Eichholz ◽

Vahini Chundi ◽

Alan Kinlaw ◽

Tenesha Medlin ◽

...

Keyword(s):

Medical Center ◽

Urgent Care ◽

Case Review ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Care Services ◽

Complex Patients ◽

Common Causes ◽

Risk Patients ◽

Recorded Data ◽

Avoidable Readmissions

Abstract Background The UNC Medical Center OPAT program was started in 2015 to provide multidisciplinary management of medically complex patients referred by the infectious diseases (ID) inpatient services and discharged on parenteral antimicrobials. A primary aim of the program is to avert avoidable readmissions during OPAT therapy through protocolized laboratory monitoring, case review and streamlined access to ID urgent care services. Methods We abstracted electronic health records for the first 250 patients enrolled in the OPAT program. 223 patients with sufficient recorded data for entire OPAT course were included. All-cause readmission events during OPAT therapy were collected, and cause for readmission was adjudicated by a multidisciplinary committee. Results Of the 223 patients, 62% were male with median age 53 years (20–88). 39 (17%) experienced a readmission (Table 1). Most readmissions occurred among patients not seen in our OPAT urgent care for the admitting complaint. 57 patients (26%) experienced at least one adverse drug reaction (ADR), e.g., laboratory abnormality, rash, or diarrhea; 7 of these required readmission. ADR was the most common reason for ID urgent care visit. Almost half of readmissions were unrelated to OPAT therapy or OPAT-related diagnosis. Less than 10% of OPAT patients utilized ID urgent care services; none of these visits resulted in readmission. Conclusion Our OPAT program represents a medically complex cohort that may be at higher risk of readmission at baseline. The availability of providers and pharmacists for urgent care services is effective in avoiding readmission for OPAT-related causes. Future interventions to address common causes of readmission include expanded access to urgent care servvices and close interval follow-up after discharge for particularly high-risk patients. Disclosures All authors: No reported disclosures.

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Identifying Actionable Causes of Potentially Avoidable Readmissions to an Oncology Service at a Safety Net Hospital

JCO Oncology Practice ◽

10.1200/op.20.00593 ◽

2020 ◽

pp. OP.20.00593

Author(s):

Vishal K. Gupta ◽

Michael Dennis ◽

Emily Mann ◽

Joseph O. Jacobson ◽

Naomi Y. Ko

Keyword(s):

Pleural Fluid ◽

Cancer Progression ◽

Medical Center ◽

Hospital Readmissions ◽

Retrospective Chart Review ◽

Safety Net ◽

Outpatient Setting ◽

Oncology Service ◽

Safety Net Hospital ◽

Avoidable Readmissions

PURPOSE: Hospital readmissions occur commonly in those receiving cancer care and result in impaired quality of life and increased costs. Causes of readmission in safety net hospitals that serve vulnerable populations are not well understood. The primary goal of this project was to identify potentially avoidable and intervenable causes of readmissions to an urban safety net hospital. METHODS: A retrospective chart review was performed on patients who were readmitted within 30 days of discharge from the hematology and oncology service at Boston Medical Center over the 6-month period between October 2018 and March 2019. Charts were reviewed by three internal medicine residents and discussed under the supervision of an attending oncologist. RESULTS: Two hundred ninety-one patient encounters involving 203 unique patients were identified in the 6-month study period. Of these 291 encounters, 80 encounters (27.5%) were followed by a readmission within 30 days and occurred in 61 (30.0%) unique patients. Nineteen (31.1%) of these 61 patients experienced two readmissions within 30 days of discharge. Twenty-five readmissions (31.3%) were classified as potentially avoidable, with the most common cause of potentially avoidable readmissions attributed to ascitic or pleural fluid reaccumulation (8, 32%). The majority of presumed nonpreventable readmissions were due to expected complications of cancer progression and treatment-related side effects. DISCUSSION: In conclusion, readmissions were common, and a modifiable reason for 30-day readmissions was identified. Addressing recurrent ascitic and pleural fluid reaccumulation in the outpatient setting could help to reduce inpatient hospital readmission on an inpatient oncology service.

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