• Discharge planning and readmissions

    The policy landscape on readmissions has shifted considerably since the end of 2009, when Public Reporting of Discharge Planning and Rates of Readmissions was published (PDF, NEJM, Jha et al.). Now Medicare payments are tied, a little, to readmission rates. Way back when, they weren’t. But Jha et al.’s paper still makes a good point and is useful for the research it cites. Public reporting of discharge planning rates may not be sufficient to influence changes in readmission rates. I hesitate to say it is insufficient to get hospitals to change at all. Maybe they do change, just not in ways that affect readmission rates.

    Anyway, some quotes from the paper, which is ungated:

    Previous studies have indicated large variations in readmission rates among hospitals [3-5] and noted substantial problems with the transition of care from the hospital to the ambulatory care sector. These problems include suboptimal communication of discharge instructions, [6] failure to reconcile hospital and ambulatory care records, and failure to arrange for appropriate ambulatory care follow-up. [7] [...]

    Some previous studies suggest that comprehensive discharge planning, effective case management, remote monitoring of the patient’s condition from his or her home, and meticulous follow-up can reduce the frequency with which patients with congestive heart failure return to the emergency room or are rehospitalized. [10,18] However, other studies have not shown, for example, that the use of nurse case managers or remote monitoring is helpful, [19] suggesting that the context and specifics of any individual program to reduce readmissions are important drivers of success. [20] [...]

    [W]e examined national performance on two quality measures currently used to assess hospitals’ discharge planning. Our findings indicate that improvements in performance on current measures of discharge planning are unlikely to have a meaningful effect. The large variation in readmission rates across health care markets suggests ample opportunity for improvement, but to substantially reduce readmission rates, we will probably need new strategies to improve transitional care in the ambulatory sector.

    @afrakt

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