• Reducing hospital readmissions

    The latest issue of Annals of Internal Medicine (AIM) includes 10 systematic reviews on topics related to patient safety. One, by Stephanie Rennke and colleagues pertains to transitions of care, which is relevant to hospital readmissions.

    Little information is available on effective transitional care strategies for general medical inpatients. Prominent national organizations have recommended a range of interventions (14), which are being implemented widely. However, little evidence supports their effect on readmissions or other important markers of postdischarge patient safety, such as emergency department (ED) visits and AEs [adverse events] occurring shortly after discharge. Moreover, a recent review (15) identified no interventions proven to reduce 30-day readmission rates in general patient populations, although it did not focus on hospital-initiated interventions. [Hyperlink added.]

    The authors point to one intervention that was successful at reducing 30-day hospital readmissions in several settings, the Care Transitions Intervention (CTI)  in which a “transition coach” conducted “postdischarge home visits that emphasized patient education and self-management.”

    In part due to limitations in study designs, their conclusion is that we don’t yet know enough about how to generalize implementation of successful strategies.

    Although hospitals are now being penalized for excessive readmission rates, the strategies that an individual hospital can implement to improve transitional care remain largely undefined.

    This and the other studies in the current AIM are ungated.


    • The readmission rule (lowering the reimbursement rate) recently adopted by CMS was mandated by ACA (to give credit (or blame) where it’s due). Some hospitals have implemented protocols to help cut re-admissions, in particular patient monitoring. Advancements in technology (such as wireless monitors) will prove extremely useful. One might ask: why did it take a blunt instrument (a cut in reimbursement) for hospitals to do what hospitals should have done anyway (i.e., patient monitoring). This is but one example of ACA matching economic incentive with patient care – and the irony of ACA critics coming from the right, of all places.

      • “This is but one example of ACA matching economic incentive with patient care – and the irony of ACA critics ”

        I do not believe things are so simple. Without a doubt hospital readmissions that are due to poor hospital care needs to be curtailed. But, the process of doing that has the potential to cause harm.

        Two items quickly come to mind. First, readmissions occur because of legitimate needs even where there is excellent care. Curtailing those readmissions might increase mortality rates. Some hospitals have shown higher readmission rates, but lower mortality rates. Perhaps they are doing the right things. Secondly it is harder to prevent readmission in those areas where the hospital serves a poorer patient population. Some of the reasons have nothing to do with the hospital so we might be penalizing the hospitals that treat lower income groups.