Readmission rates respond to collaborative process
Working together multiplies benefits
There's not a healthcare organization around that isn't focused on reducing unplanned readmission rates. They cost money and are the focus of a variety of regulatory and payer organizations that are either no longer paying for care related to such readmissions or will soon stop.
But as much as everyone wants to find some magic bullet that will work in multiple settings, the truth is that no one thing is going to solve the problem. Indeed, what works at one hospital for a particular type of patient might not work at another hospital 50 miles away for the exact same patient. That system makes the idea of a state hospital association collaboration something of a head scratcher. If it all depends on where you are, the kind of patient, the time of day, and phase of the moon, then really, shouldn't we all just figure it out on our own?
Absolutely not, says Alison Hong, MD, director of quality and patient safety of the Wallingford, CT-based Connecticut Hospital Association. Hong is working with hospitals in Connecticut on a multi-year collaborative to address statewide readmissions for congestive heart failure (CHF). People are forgetting one key aspect to the question: whether what any hospital does in isolation from the rest of the healthcare continuum does will make much difference at all.
That's part of what makes this collaborative different: It involves not just association member hospitals, but also organizations outside the acute care setting who are involved in caring for these patients: nursing homes, home care, and community physician practices, large and small. All of the parties are working together, looking through data, performing chart reviews, and going through every possible process to find common factors that lead to unplanned readmissions among CHF patients. The group is using the Institute of Healthcare Improvement's (IHI) Transforming Care at the Bedside document as its QI template. (For more information about accessing this document, see resource, below.)
The collaborative started last year, in person and electronically, to focus on five strategies:
- delivering evidence-based care;
- using enhanced admissions assessments of post-discharge needs — start planning for discharge as soon as the patient is on the unit, talking with family, discussing social issues, medication issues, and logistical issues that might arise;
- engaging family and patients — identifying the right caregiver, asking patients why they think they returned to the hospital, using advanced teach-back methods;
- medication safety;
- post-acute care follow-up — requiring patients to have an appointment with a community physician or clinic made before they leave the hospital and see they get to that appointment within seven days of discharge, with no outstanding issues to address, including transportation to the appointment.
This is the fifth collaborative that the members of the hospital association have worked on, says Hong. There is a lot of interest in it and in using the team dynamic to create traction. Even those with fairly low CHF readmission rates are working on this and seeing an effect.
"We all know that this is important to community health and the patient. We all know that this is going to be our parents in a few years, or us."
Source/ Resource
For more information on this topic contact:
- Alison Hong, MD, Director of Quality and Patient Safety, Connecticut Hospital Association, Wallingford, CT. E-mail: [email protected].
- IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement Transforming Care at the Bedside. (Available on www.IHI.org)
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