Thursday, March 18, 2010

Four Factors That Drive Hospital Readmissions

Hospital readmissions besides being hard on the patient are also detrimental to the hospital, both financially and on their quality scoring. Medicare is now tracking the level of each hospital's readmissions. There are a variety of factors that lead to preventable readmissions, but these usually have to do with poor outpatient management and followup after discharge. Because of our current disjointed system of care, there is often not a smooth hand off for the patient who will need monitoring and treatment at some level after discharge. Patients sometimes leave the hospital with incomplete treatment plans or medications they do not understand.

Clearly we need to do a better job of coordinating services post discharge. But what if we could do a better job in identifying those patients who were at a higher risk for readmission while they were still hospitalized? Researchers at the Ottawa Hospital Research Institute have created a score card to help determine if a patient is at high risk of readmission, or death. Their study included 1 million patients discharged from hospitals between 2004 and 2008. By looking a four factors, they could predict with 70% accuracy, those patients at high risk for readmission. These factors are:

1) Length of the patient's hospital stay
2) How sick they were upon arrival
3) The number of illnesses diagnosed during hospitalization
4) The number of Emergency Department visits during the six months prior to hospitalization

Researchers found that a combination of these factors greatly increases risk. Using this scorecard allows hospitals to identify those patient to focus on for more intense discharge management.

This discharge management can go to various levels of intensity based upon the risk factors of the patient. Those of lower risk may get by with printed discharge instructions. Some may need a followup call from the pharmacist to explain the new home meds. Some hospitals have a hot line for use by patients or their families with any questions. And finally for the highest risk patients, hospitals have them on biometric monitoring devices that send vitals and other symptoms to a transition management team. This final approach is costly but seen as worthwhile investment to prevent readmission or possibly even death.

Doing a better job of discahrge management and reducing preventable readmission makes sense. It saves money. It improves the quality of care provided by the hospital. But most of all it is better for the patient.

More on this later.

Mark Brodeur

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