Elizabeth H. Bradley, Leslie Curry, M.P.H., Ph.D., Leora I. Horwitz, M.D., Heather Sipsma, Ph.D., Jennifer W. Thompson, M.P.P., Mary Anne Elma, M.P.H., Mary Norine Walsh, M.D., and Harlan M. Krumholz, M.D.
A majority of hospitals participating in a national campaign to reduce preventable hospital readmissions have taken preliminary steps to avoid readmissions of patients with heart failure or acute myocardial infarction, including monitoring readmission rates. But many important practices, such as alerting outpatient physicians of a patient’s discharge within 48 hours, are only infrequently in place.
Nearly one-quarter of patients hospitalized with heart failure and one-third of patients hospitalized with acute myocardial infarction (AMI) are readmitted within 30 days of discharge, despite evidence that a substantial portion of readmissions may be preventable. While these and other readmissions increase Medicare costs by an estimated $17 billion per year, little is known about the extent to which hospitals have employed recommended strategies to reduce readmission risk. As part of a Commonwealth Fund–supported study, researchers surveyed more than 500 U.S. hospitals to determine their use of 10 practices associated with lower readmission rates.
Infrequent use of practices shown to reduce the rate of hospital readmission for heart failure may be attributable to a number of factors, including insufficient resources and constraints on staff time. It may also reflect the complexity of coordinating efforts among physicians, pharmacists, nurses, and many of the ancillary staff to achieve a smooth discharge. Standardizing systems for reducing readmissions may address some of these challenges.
The authors surveyed 537 hospitals enrolled in the American College of Cardiology and the Institute for Healthcare Improvement’s "Hospital to Home" quality improvement initiative, which strives to reduce preventable 30-day readmissions by 20 percent by the end of 2012.
Hospitals' use of recommended practices to reduce readmission rates varies significantly, with the greatest variation in the use of medication management techniques and discharge and follow-up procedures. This suggests there is significant opportunity for continued improvement in communication and care coordination.