December 2010 Volume I, No. 12 | |
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Dear Healthcare Intelligence Network Client,
This issue is full of ideas to curb avoidable readmissions — from launching a nurse advice line to dispensing medication adherence advice at key care junctures. And to learn more ways to reduce hospital readmissions, please join the more than 50 healthcare companies that have already taken our second annual e-survey on Reducing Hospital Readmissions. Complete the survey by December 31 and you'll receive a free e-summary of survey benchmarks.
With this issue, ReadmissionsRx marks one year of publication. We thank you for your readership and look forward to serving your healthcare information needs in 2011.
Patricia Donovan Editor, ReadmissionsRx |
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This week's ReadmissionsRx news:
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Most Medicare Stroke Patients Die Or Are Rehospitalized Within Year After Discharge
After leaving the hospital, nearly two-thirds of Medicare beneficiaries hospitalized for acute ischemic stroke either died or were rehospitalized within a year, according to a UCLA-led study.
The findings point to an opportunity for more quality-of-care initiatives to improve stroke care, especially in transitioning to home, stroke rehabilitation and outpatient care.
The study, which appeared online in Stroke, a journal of the American Heart Association, also found that hospital mortality and readmission rates varied widely nationwide, indicating there may be substantial opportunities to improve stroke care and reduce variations in clinical outcomes, the researchers said.
An academic team analyzed data on outcomes for more than 90,000 Medicare patients admitted between 2003 and 2006 to 625 hospitals participating in the Get With the Guidelines–Stroke Program, a national registry for stroke hospitalizations.
All the patients had fee-for-service Medicare insurance. The average patient was 79 years old, 58 percent were female and 82 percent were white. Patients were hospitalized for the most common type of stroke — an acute ischemic event, which occurs due to an obstruction within a blood vessel that supplies blood to the brain.
The team found that the total unadjusted in-patient hospital mortality rate was 6.1 percent, the mortality rate 30 days after hospital admission was 14.1 percent and the mortality rate one-year from admission was 31.1 percent.
Within the first year after hospital discharge among stroke patients who survived and were released from the hospital, the death rate was 26.7 percent, and the readmission rate was 56.2 percent. The overall rate of death or readmission was 61.9 percent.
Even when risk-adjusting for hospital differences such as bed size; the region of the country; the type of facility, such as an academic or community hospital; and whether or not the hospital had a Joint Commission primary stroke center designation, there was very little difference in outcomes. Academic hospitals and those in the Northeast and West had just slightly more favorable outcomes.
Researchers also found that there were no improvements in mortality or rehospitalization rates in this population for the entire time period studied, 2003 to 2006.
For more information, please visit:
HealthSounds Podcast: Nurse Advice Line Ensures Appropriate Utilization
Reducing Heart Failure Readmissions
And finally, we make sure that every discharged patient has an appointment with a healthcare provider within seven days of discharge. The literature tells us that is the most vulnerable time frame for readmission, if the patient is not seen within those first seven days. We’re making a big push for our clinic as well as our private patients to make sure that they are seen by somebody in the community within seven days of discharge.
New Chart: Points in Care for Medication Adherence
Healthcare Trends for 2011
Minnesota Pilot Reduces Readmissions By Up to 44% In Early Results
In results through September, 27 patients were readmitted to Fairview Southdale out of 292 original admissions among the group. The 9.25 percent readmission rate compares to a 16.5 percent readmission rate to the same hospital in 2009 among a similar population.
The good news came nine months into a pilot project designed to keep Medicare Advantage patients from returning unnecessarily to the hospital within 30 days of discharge.Begun Feb. 1, the pilot project is a joint effort of Fairview Physician Associates, UCare and Fairview Southdale Hospital to improve patient care and experience, and reduce costs. While the pilot intervened with all admitted UCare for Seniors patients in the group, efforts targeted those with diabetes, chronic obstructive pulmonary disease and heart disease.
Key interventions by FPA nurse case managers, hospital social workers, hospitalists, medical records and pharmacists helped drive the results. Together they worked to prevent misunderstanding about medications, lack of self-care awareness, barriers to follow-up clinic visits and other common reasons causing patients to be readmitted.
For example, a patient with diabetes and heart failure returns home after a hospital stay for shortness of breath and heart-failure related weight gain. At home the patient may not have a family members available to help him take his medications correctly, eat the right foods and weigh himself to check for fluid retention. He could miss warning signs that might land him back in the hospital.
While some patients will need to be readmitted to the hospital, preventing avoidable readmissions keeps patients healthy and holds costs down. Each prevented readmission could save $10,000 in avoidable cost, Nersesian says. Extended across all Fairview hospitals and insurance payors, the project could save several million dollars, he adds.
The project has reduced between 30 and 44 percent of readmissions, “depending on how you measure and define the readmissions,” says William Nersesian, MD, MHA, chief medical officer of Fairview Physician Associates (FPA) a netowrk of 1,200 independent, Fairview-employed and University of Minnesota primary and specialty physicians.
Survey of the Month: Reducing Hospital Readmissions
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More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable ER use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line.
Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see at which points in care organizations were most heavily focused on improving medication adherence.
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