scholarly journals Assessing 30-day avoidable readmission rates: Is it an appropriate tool to manage emergency department quality of care?

2020 ◽  
Vol 9 (3) ◽  
pp. 11
Author(s):  
Agri Fabio ◽  
Eggli Yves ◽  
Fabrice Dami
Keyword(s):  
Quality Indicator ◽  
Low Cost ◽  
Hospital Readmissions ◽  
Healthcare Providers ◽  
Quality Level ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Avoidable Readmission ◽  
Record Review ◽  
Avoidable Readmissions

Objective: Quality indicators, based on administrative data, are being increasingly used to assess avoidable hospital readmission rates. Their potential to identify areas for improvement at low cost is attractive, but their performance in emergency departments (EDs) has been criticised.Methods: Hospital readmissions were categorised as potentially avoidable or non-avoidable, by a computerised algorithm (SQLape®, version 2016 - Striving for Quality Level and analysing of patient expenditures). Half-yearly rates were reported between July 2015 and June 2016. Two senior physicians conducted a medical record review on 100 randomly selected cases from an ED, flagged as potentially avoidable readmissions (PAR). Results were then discussed with the algorithm’s designer.Results: The algorithm screened 2,182 eligible emergency visits - 105 cases (4.8%), were deemed potentially avoidable by the algorithm. Among 100 randomly selected cases, nine exclusions were due to coding issues and four due to false positives. Overall (N = 87), 20/87 (23%) of readmissions were directly related to sole emergency care, 31/87 (36%) related to healthcare providers other than the ED, and 23/87 (26%) were of mixed provision, while 13/87 (15%) were attributed to the course of the disease.Conclusions: The study confirms the need for a better understanding of the algorithm’s measurement and of its reported results. Careful interpretation is required before a sound conclusion can be made. Indeed, it is apparent that the 30-day PAR quality indicator rate reflects a wider parameter of care than hospitals alone, who understandably tend to concentrate on their own, direct liability of care. In particular the 30-day PAR quality indicator is not well-suited to evaluate ED performance.

Abstract 256: Readmission Avoidability in Acute Coronary Syndrome Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Maria Souphis ◽  
Rachel Sylvester ◽  
Alison Wiles ◽  
Meghana Subramanian ◽  
William Froehlich ◽  
...  
Keyword(s):  
Transitional Care ◽  
Drug Effects ◽  
Care Program ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
History Of ◽  
Definition Of ◽  
Avoidable Readmission ◽  
Cancer Complications ◽  
Avoidable Readmissions

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.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

scholarly journals Reduction of 30-Day Hospital Readmissions after Patient-centric Telephonic Medication Therapy Management Services

2016 ◽  
Vol 51 (11) ◽  
pp. 907-914 ◽  
Author(s):  
Daryl E. Miller ◽  
Teresa E. Roane ◽  
Karen D. McLin
Keyword(s):  
Hospital Discharge ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Medication Therapy Management ◽  
Medication List ◽  
Readmission Rates ◽  
Therapy Management ◽  
Medication Therapy ◽  
Hospital Readmission Rates ◽  
Significant Difference

Background Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. Objective To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. Methods A retrospective chart analysis ( n = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. Results The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio, 1.04; 95% CI, 0.68–1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Conclusion Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.

scholarly journals Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

2019 ◽  
Vol 36 (2) ◽  
pp. 47-53
Author(s):  
Julie B. Cooper ◽  
Elizabeth Jeter ◽  
Cory John Sessoms
Keyword(s):  
Internal Medicine ◽  
Hospital Readmission ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
General Internal ◽  
Hospital Readmission Rates ◽  
Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

A Need for Greater Collaboration

2017 ◽  
pp. 328-350
Author(s):  
Mariette Sourial ◽  
Jo Ann M. Bamdas ◽  
Angelica Constanzo ◽  
Marina E. Ishak
Keyword(s):  
Healthcare System ◽  
Interprofessional Education ◽  
Hospital Readmissions ◽  
The United States ◽  
Collaborative Practice ◽  
Health Providers ◽  
Readmission Rates ◽  
Comprehensive Overview ◽  
Hospital Readmission Rates ◽  
New Policies

Patient safety concerns have risen to such levels that multiple organizations and initiatives have been created to reduce hospital readmissions and medication errors in the United States healthcare system. Interprofessional education and collaborative practice (IPECP) has become a center of focus in healthcare education and the competency-based programs help health providers function more effectively as a team, train new university and college healthcare students to become ready for collaborative practice, and assist in making new policies and practices to improve today's healthcare system. This chapter provides a comprehensive overview of healthcare initiatives created to help lower hospital readmission rates and polypharmacy errors. These projects, programs, and initiatives optimize patient care while minimizing costs. With pharmacists, physicians, nurses, social workers, and other professionals and caregivers build better teams with improved communication and understanding each other's roles and responsibilities, the global healthcare system will overcome the numerous challenges.

Right TraC™ Post-Hospitalization Care Transitions Program to Reduce Readmissions for Hemodialysis Patients

2017 ◽  
Vol 45 (6) ◽  
pp. 532-539 ◽  
Author(s):  
Rebecca L. Wingard ◽  
Kathryn McDougall ◽  
Billie Axley ◽  
Andrew Howard ◽  
Cathleen O''Keefe ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Information Exchange ◽  
Repeated Measures ◽  
Hospital Readmissions ◽  
Care Transitions ◽  
Readmission Rates ◽  
Hospitalization Rates ◽  
Hospital Readmission Rates ◽  
Nonrandomized Trial

Background: Hemodialysis (HD) patients have high hospitalization rates. This nonrandomized trial tested the effect of a bundle of renal-specific “Right TraC™” strategies on 30-day all-cause readmission rates and, secondarily, 90-day readmissions and overall admissions among HD patients. Methods: Twenty-six Fresenius clinics in West Virginia, Ohio, and Kentucky participated in the interventions. Eighteen matched clinics served as controls; intervention clinics also served as their own controls. We deployed the intervention in 3 incremental phases focused on patient information exchange, post-hospital follow-up, and telephonic case management. Thirty-day hospital readmissions per patient year (ppy) were calculated by dividing the total number of readmissions within 30 days of index admission by the total number of patient-years in baseline (2012) and remeasurement (2014) periods. We also compared readmission rates from 2010 to 2015. We used repeated measures Poisson regression to compare outcomes between groups and time periods. Results: From 2012 to 2014, 30-day all-cause readmissions ppy declined for Right TraC clinics (from 0.88 to 0.66 [p < 0.001]; for controls, from 0.73 to 0.61 [p = 0.16]). Difference in change between groups was nonsignificant (p = 0.26). Overall admissions ppy declined: for Right TraC clinics from 2.51 to 1.97 (p < 0.001); for controls from 2.14 to1.92 (p = 0.21); difference in change between groups was significant (p = 0.01). For 2010, 2011, and 2012, Right TraC clinic 30-day readmissions ppy were unchanged: 0.89, 1.00, 0.88 (p = 0.61 and p = 0.49); they declined to 0.66 (p < 0.001) in 2014 (intervention year); rose to 0.70 (p = 0.06) in 2015 (interventions discontinued). Conclusion: We conclude that Right TraC interventions may have been helpful in reducing hospital readmission rates.

scholarly journals Successful hospital readmission reduction initiatives: Top five strategies to consider implementing today

2018 ◽  
Vol 7 (5) ◽  
pp. 16 ◽  
Author(s):  
Bita A. Kash ◽  
Juha Baek ◽  
Ohbet Cheon ◽  
Nana E. Coleman ◽  
Stephen L. Jones
Keyword(s):  
Hospital Readmission ◽  
Discharge Planning ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Readmission Rates ◽  
Effective Interventions ◽  
Hospital Readmission Rates ◽  
Weighted Means ◽  
Pubmed Database

Only one quarter of U.S. hospitals demonstrated low enough levels of 30 day readmission rates to avoid penalties imposed by the Hospital Readmissions Reduction Program (HRRP) in 2016. Previous work describes interventions for reducing hospital readmission rates; however, without a comprehensive analysis of these interventions, healthcare leaders cannot prioritize strategies for implementation within their healthcare environment. This comparative study identifies the most effective interventions to reduce unplanned 30-day readmissions. The MEDLINE-PubMed database was used to conduct a systematic review of existing literature about interventions for 30-day readmission reduction published from 2006 through 2017. Data were extracted on hospital type, setting, disease type, intervention type, study sample, and impact level. Of 4,886 citations, 508 articles were reviewed in full-text, and 90 articles met the inclusion criteria. Based on the three analytic methodologies of means, weighted means, and pooled estimated impact level, the most effective interventions to reduce unplanned 30-day admissions were identified as collaboration with clinical teams and/or community providers, post-discharge home visits, telephone follow-up calls, patient/family education, and discharge planning. Commonly, all five interventions identify patient level engagement for success. The findings reveal the need for shared accountability towards desired outcomes among health systems, providers, and patients while providing hospital leaders with actionable strategies that can effectively reduce 30-day readmission rates.

The Effectiveness of Transition Interventions to Support Older Patients From Hospital to Home: A Systematic Scoping Review

2020 ◽  
pp. 073346482096871
Author(s):  
Renee O’Donnell ◽  
Melissa Savaglio ◽  
Helen Skouteris ◽  
Jane Banaszak-Holl ◽  
Chris Moran ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Readmissions ◽  
Well Being ◽  
Evidence Base ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Hospital To Home ◽  
The Impact ◽  
Health And Well Being

Background: Interventions supporting older adults’ transition from hospital to home can address geriatric needs. Yet this evidence base is fragmented. This review describes transitional interventions that provide pre- and post-discharge support for older adults and evaluates their implementation and effectiveness in improving health and well-being. Method: Articles were included if they examined the extent to which transitional interventions were effective in improving health and well-being outcomes and reducing hospital readmission rates among older adults. Results: Twenty studies met the inclusion criteria. Four types of interventions were identified: education-based (10/20); goal-oriented (4/20); exercise (4/20); and social support interventions (2/20). Education and goal-oriented interventions were effective in improving health and well-being outcomes. The impact of interventions on mitigating hospital readmissions was inconclusive. Only five studies examined implementation. Discussion: Older adults transitioning from hospital to home would benefit from tailored education and goal-oriented interventions that promote their capacity for self-care.

A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke

2021 ◽  
pp. 194187442110366
Author(s):  
Ann M. Leonhardt-Caprio ◽  
Craig R. Sellers ◽  
Elizabeth Palermo ◽  
Thomas V. Caprio ◽  
Robert G. Holloway
Keyword(s):  
Ischemic Stroke ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Post Discharge ◽  
Readmission Rates ◽  
Improvement Project ◽  
Risk Of Death ◽  
Hospital Readmission Rates ◽  
Number Of Patients

Background: Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care. Methods: Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018. Results: Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores. Conclusions: An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.

A Need for Greater Collaboration

2017 ◽  
pp. 65-87
Author(s):  
Mariette Sourial ◽  
Jo Ann M. Bamdas ◽  
Angelica Constanzo ◽  
Marina E. Ishak
Keyword(s):  
Healthcare System ◽  
Interprofessional Education ◽  
Hospital Readmissions ◽  
The United States ◽  
Collaborative Practice ◽  
Health Providers ◽  
Readmission Rates ◽  
Comprehensive Overview ◽  
Hospital Readmission Rates ◽  
New Policies

Patient safety concerns have risen to such levels that multiple organizations and initiatives have been created to reduce hospital readmissions and medication errors in the United States healthcare system. Interprofessional education and collaborative practice (IPECP) has become a center of focus in healthcare education and the competency-based programs help health providers function more effectively as a team, train new university and college healthcare students to become ready for collaborative practice, and assist in making new policies and practices to improve today's healthcare system. This chapter provides a comprehensive overview of healthcare initiatives created to help lower hospital readmission rates and polypharmacy errors. These projects, programs, and initiatives optimize patient care while minimizing costs. With pharmacists, physicians, nurses, social workers, and other professionals and caregivers build better teams with improved communication and understanding each other's roles and responsibilities, the global healthcare system will overcome the numerous challenges.

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