October 2010 Volume I, No. 10 | |
|
Dear Healthcare Intelligence Network Client,
While chronic illness is a key indicator of risk for readmission to the hospital, don't write off the warning signs of depression and nutrition, advise Australian researchers. Also in this issue, learn how Michigan is expanding its efforts to reduce readmissions by differentiating between readmissions and rehospitalizations — and designing interventions to reduce both.
This issue also charts ROI from case management programs, shares a forecast for healthcare in 2011 and gives you a chance to weigh in on the year ahead with this month's e-survey.
Patricia Donovan Editor, ReadmissionsRx |
|
|
This week's ReadmissionsRx news:
Table of Contents
Join our Community:
Please send comments, questions and replies to
pdonovan@hin.com. Publisher:
HIN podcasts
Contact HIN:
|
4 Risk Factors for Readmission
Two studies published in the Journal of Hospital Medicine have four identified key clinical and sociodemographic risk factors for readmission to the hospital.
African-Americans and Medicaid beneficiaries have the highest risk of readmission, with a 43 percent and 15 percent increased risk of readmission respectively after adjustment for other variables, according to the first study, conducted at the University of California San Francisco (UCSF).
A second smaller study by Australian researchers of readmissions risk factors found that poor nutrition and depression are associated with higher healthcare use in vulnerable populations. The study focused on individuals with two or more admissions in the preceding six months.
The UCSF researchers determined that the clinical factors most often associated with readmission are high-risk medications and six comorbidities (congestive heart failure, renal disease, cancer (with and without metastasis), weight loss and iron deficiency anemia).
The UCSF study looked at factors behind unplanned hospital readmission within 30 days – which occurs in nearly one in five Medicare patients in the United States. The study involved patients admitted to UCSF hospitals between June 2006 and May 2008; 6,805 unique patients for a total of 10,359 admissions. 17 percent of admissions were readmitted within 30 days, with almost half of these (49.7 percent) occurring within 10 days.
For the second study, researchers at Australia's Royal Brisbane and Women’s Hospital assessed 142 patients aged over 50 admitted between February 2006 and February 2007 who had two or more hospitalizations in the preceding six months, looking at the factors of depression, nutritional status, and functional status as well as demographic and disease variables.
After six months, 55 participants (38.7 percent) had had a total of 102 unplanned admissions to the hospital. As the researchers expected, the strongest predictor of readmission was the presence of a chronic disease diagnosis, but alongside this, they found that BMI had a non-linear relationship with readmission, with a higher risk in those underweight and obese; 72 percent and 50 percent of each category respectively were readmitted compared to 27 percent of those with normal weight and 37 percent of those classed as overweight. Depressive symptoms were also associated with a higher risk of readmission (47 percent readmitted). Age, sex, number of previous admissions and discharge support were not significantly influential.
For more information, please visit:
HealthSounds Podcast: Two Opportunities from Healthcare Reform
Creating Successful Care Partnerships
New Chart: Case Management ROI
Benchmarks in Reducing Avoidable ER Visits
Michigan Targets Care Transitions to Reduce Rehospitalizations
While readmissions generally refer to patients being readmitted to hospitals in which they originally received care, rehospitalizations refer to patients being readmitted to any hospital, regardless if it is the facility in which care was originally received.
The Michigan STate Action on Avoidable Rehospitalizations (MI STA*AR) hopes to tighten patient care transitions — the process of moving a patient from the hospital setting to home care or another healthcare setting — by enhancing patient communication and providing timely follow-up after hospital discharge.
Hospitals participating in MI STA*AR pledge to commit significant staff time, resources and leadership to reduce avoidable rehospitalizations by focusing on four key areas:
In May 2009, Michigan was one of three states selected by the Institute for Healthcare Improvement (IHI) to participate in the four-year initiative. The following month, a representative group of Michigan hospitals were chosen for a pilot collaborative to test interventions and develop reliable processes. The Michigan project is kicking off its statewide expansion this fall, as are those efforts hosted in Massachusetts and the state of Washington.
MI STA*AR provides participating facilities with an understanding of the underlying issues that lead to avoidable rehospitalizations, as well as how to implement interventions and redesign processes to reduce them. The program also aims to help hospitals comply with provisions in federal healthcare reform effective in October 2012 that will assess Medicare reimbursement penalties related to certain readmissions and rehospitalizations. Notably, hospitals will not only be penalized for readmissions to their own facility, but also when their former patients are rehospitalized in other facilities.
Survey of the Month: Healthcare Trends for 2011
Thank you for your readership!
Please urge your colleagues to subscribe by forwarding this email or visiting
While we encourage you to forward this email to your
colleagues, these articles may not be redistributed in any other publication,
reproduced for publication in any form, distributed on an intranet or network or
by e-mail distribution or distributed for commercial purposes without the expressed
written permission of the Healthcare Intelligence Network.
|
Steven Valentine, president of The Camden Group, defines two major opportunities built into healthcare reform that will help healthcare organizations to bend the spend curve and improve profitability.
Healthcare case management programs are significantly influencing hospital readmission rates, medication compliance, healthcare costs and other industry metrics. We wanted to see the ROI generated by healthcare case management programs.
|
|