12 Ways to Reduce Hospital Readmissions

Cheryl Clark, for HealthLeaders Media , December 27, 2010

6. Identify Frequent Flyers
Customize your hospital's admission and re-admission rates for demographic and disease characteristics to identify those at highest risk, and expend extra resources on their care needs. This may involve special programs for homeless patients, such as the one effort by a cohort of Los Angeles hospitals who grappled with how to safely discharge homeless patients without violating city laws.

The Los Angeles project now discharges homeless patients who meet certain criteria to a half-way type of house in nearby Bell, and saved $3 million for hospitals in its first few months. Expansions in other parts of Southern California are underway.

7. Understand What's Happening After Discharge
Kaiser Permanente is using video cameras to chronicle home settings and the entire care process to determine what's happening to the patient after discharge that provoked a readmission.

The team is also using video of the care team, from the pharmacist, home care providers, nurses, and physicians about their care of that patient, to highlight wrinkles and cracks in the system that brought the patient back to the hospital.

So far, Kaiser officials say that the video project has contributed to a reduction in readmission rates at some hospitals where it has been tried, such as from 15.7% to 9% at Kaiser's South Bay Medical Center near Los Angeles, because it gave the team information to streamline care, says Kaiser's Neuwirth.

8. Provide Home Care on Wheels
Just like Meals-on-Wheels can be scheduled in advance, so can case management, housekeeping services, transportation to the pharmacy and physician's office. At Piedmont Hospital in Atlanta, in collaboration with the Area Agency on Aging, patients having elective knee surgery get coupons and prescheduling, "so that by the time you get out of the hospital, it's waiting there for you," Boutwell says. She adds that this kind of a pre-arrangement for post-transition care is "spreading like wildfire," among a number of hospitals, but so far it's mainly being tried with elective patients.

9.  Consider Physician Medication Reconciliation
A recent paper in the New England Journal of Medicine by Yuting Zhang, of the University of Pittsburgh noted the wide geographic variation among physicians' prescribing practices with medications that should be avoided in patients over age 65. She also noted variation in prescribing practices for drugs that have a high risk for negative drug-disease interaction.

Jencks says that Zhang and colleagues "are pointing us to a rather important gap in the most common thinking about transitions—that we are to make sure that patients are able to get and take medications, get recommended follow-up, and generally do as they are told. But we know that medication plans can be in life-threatening error, that physicians often recommend a time-to-follow-up that is too long, that discharge plans are often written in ignorance of the patient's pre-admission history and experience. In general, we need to be much more critical of the plans patients get."


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10 comments on "12 Ways to Reduce Hospital Readmissions"

Rick Bloemen (10/1/2012 at 11:52 AM)
I agree with Charlene Perrone and her comments that a big piece of the puzzle is during the discharge process. How much real information and true guidance are the families getting. Should they just be discharged to go home? Do they need in-home care to help monitor and administer care? Should they be sent to assisted living and if so, which one ? I have seen the practice over and over where a family is given "The Blue Book" and left to their own resources. And then we all wonder why there is a recurring readmission rate.In our business, we are a placement agency, we visit and rate the homes, work with in-home care agencies, meet and spend hours of time with the families doing assessments for care and budgets and then we tour the family to the different homes, to match the patient with the right care. Case managers do not have the time or resources to know which particular home would be the right choice. They do not visit each home and see the layouts for handicap accessability and function, diet control etc. I ask the question as did Charlene Parrone, that has an in-home care company, why not get out of the box and use other professionals to help? There are ways of screening out the non-legitimate companies. And I ask, what is better The system we have that is failing or to try a new approach? Or do we continue just handing out "The Blue Book" closing our eyes and hope that it works this time.

Charlene Perrone (8/2/2012 at 8:53 PM)
I find that there's something missing in our discussion regarding reducing hospital readmissions, and that's the non-medical home care component. Health Plans, hospitals, even physicians are looking for strategies to reduce readmission rates including hiring hospitalists, additional social workers, and nurses. But no-one is talking about the most cost-effective way to discharge patients appropriately and assist them in recuperating at home. Non-medical home care companies like mine have skilled, experienced caregivers who are well-versed in the discharge process, understand medications and dme, are able to monitor vital signs once the patient is home and under periodic home health care, and can support the patient every step of the way in his or her recuperation...at home. Home Instead Senior Care has even developed its own "hospital-to-home" evidence-based program called Returning Home, which is proven to have helped Medicare patients avoid hospital readmission within that critical 30-day period. The program includes a strategy for tracking patients so that hospitals and home health agencies can understand and improve the benefits of this vital collaboration. I realize that the low-income and minority populations are most at risk for hospital readmissions, and clearly that's a problem when it comes to non-medical home care, because right now the only way to cover our service is through private pay, long-term care insurance or veterans' benefits. That's why health care facilities and insurance plans need to be creative...and understand how important a piece of this collaborative puzzle we are. They need to figure out a way to commission or contract with companies like mine to assist their patients at discharge. As an example, a hospital or health plan might think of partnering with a legitimate company or group of companies like mine and paying for a certain number of hours with their patients to make sure the discharge papers are in order, that all dme is ordered, that a home health agency has been prescribed, and then to transport them, to make sure all meds are in place, to ensure they have adequate food and supplies, and to do follow-up to make sure the patient is following all discharge orders. Working together, we can reduce significantly the number of hospital readmissions; I know this for a fact. I just don't know if anyone in the health care industry is listening. C. Perrone

Janet Thurston MSN (1/21/2012 at 8:20 PM)
Everything written creates a safer, better experience for all patients. With this information now coming into realization, why is it so difficult to do? ie Pts go home with their meds understanding them, Dr follow up appts arranged. Pt questions answered. Why would a pt have to pay 100$ for a copy of their medical record? This is another shame. Dr to Dr / free Dr to Pt / fee




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