Elizabeth H. Bradley, Heather Sipsma, Leora I. Horwitz, Leslie Curry, and Harlan M. Krumholz
E. H. Bradley, H. Sipsma, L. I. Horwitz et al., "Contemporary Data About Hospital Strategies to Reduce Unplanned Readmissions: What Has Changed?" JAMA Internal Medicine, published online Oct. 21, 2013.
Nearly one of five hospitalized Medicare beneficiaries is readmitted to the hospital within 30 days, costing the Medicare program more than $17 billion annually. To reduce the need for readmissions and improve patients’ health and well-being, many hospitals are participating in quality improvement campaigns focused on this problem. To assess progress, Commonwealth Fund–supported researchers surveyed hospitals taking part in the Hospital to Home (H2H) initiative, a national campaign cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement, at baseline in 2010–11 and then again in 2011–12.
Compared with baseline findings, responses to the follow-up survey showed that significantly more hospitals were partnering with other local hospitals to reduce readmissions; discharging patients with a follow-up appointment already made; and tracking the percentage of patients discharged with follow-up appointments within seven days and those readmitted to other hospitals. In addition, more hospitals were estimating the risk of readmission in a formal way, using electronic forms for medication reconciliation, and using “teach-back” techniques, in which health care providers ask patients to state in their own words the clinical instructions given to them or decisions about their treatment.
For many of the recommended strategies, however, the researchers did not see a significant increase in usage. At follow-up, less than 40 percent of hospitals had a process in place for alerting outpatient physicians about discharges within 48 hours or for following up on test results that came back after the patient was discharged. Less than one-quarter of hospitals reported always sending the discharge summary to the primary care physician, and less than two-thirds reported always conducting nurse-to-nurse reports before releasing patients to nursing homes.
Even with financial incentives, many hospitals are not implementing all recommended strategies that have been shown to reduce readmission rates.