Tuesday, September 13, 2011

Reducing healthcare costs: cutting readmissions

Many studies have looked at this. This study estimates that 15% return to hospital before 30 days. This is an expensive and costly mistake.
"A report released today says the cost of patients returning to hospitals within 30 days of a stay—known as readmissions—is costing the state (New York) $3.7 billion each year." - read the Morning Call article

 Reducing Hospital Readmissions in New York State 

At least four factors are widely viewed as important to effective discharge planning:
(1) coordination between the hospital-based and primary care physician,
(2) better communication between the hospital-based physician and the patient,
(3) better education and support for patients to manage their own condition, and
(4) reconciliation of medications at discharge or immediately afterward (Kripalani et al. 2007). While many of the most promising interventions for lowering readmission rates address some or all of these factors, relatively few have been rigorously evaluated (Minott 2008).

Other studies show that 4) is a huge issue. Some seniors, my parents included, did not hear well, and may not have been able to follow directions. My mom had at least one infection following 5 cancer surgeries. This required extensive home support by a nurse, another drain on the system. My mother, having had her chemo ended with her blood clot, choose to go home and not have pain meds filled. She is not the only one...

Patients leave hospital without meds

This study adds to a body of other literature about medication adherence. A separate study in the American Journal of Cardiology shows that patient medication adherence cuts hospitalizations by 9 percent and reduces costs by as much as $944 in cholesterol patients.

This New York study may well be applicable to Canada, as they discuss a financial reward for reducing readmissions. While follow-up phone calls were shown as effective as more expensive interventions, e.g., nurse advocate to assist the patient upon discharge, the lack of communication, and the phone calls by medical staff, cannot be charged, I would imagine, and may not be seen to be worthy of staff time.

It would seem to me that follow-up care and prevention would be a normal part of physician care. This is hard to explain, how many times patients return to a hospital setting.

For more information:
- check out the report (.pdf)

Transitional care patient 'coaches' cut hospital readmissions

Typically, 20 to 25 percent of patients age 65 and older are readmitted after 30 days, according to a (Canadian) press release. However, with intervention, a visiting coach can help cut the rate of readmissions.

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