“Decrease readmissions, and decrease them stat!” This mantra, or some, perhaps more subtle version thereof, is echoed over and over at hospitals across the country, and for good reason. Not only do readmissions have the potential to cost hospital systems millions of dollars through Medicare payment reductions, they also signal a more important, though less vocalized concern. If our patients keep returning to the hospital, are we really providing them with 100% of the resources they need?
On the surface, it may seem like there is little we can do for that two-pack-per-day smoker with end-stage chronic obstructive pulmonary disease who keeps getting readmitted with an exacerbation. And, while in reality, we may never get him to stop smoking and start taking his mediations as prescribed, perhaps we can help decrease the frequency of readmissions from three to four per year to two to three. While seemingly small, this decrease is actually quite dramatic, correlating to a 25%-50% reduction in the use of hospital services, not to mention the profound impact that fewer days spent in the hospital will have on his quality of life.
It is remarkable how much change occurs in the health care system over time. One year a drug may be touted as a huge breakthrough in treatment, and the next it may be taken off the market because of previously unrecognized, potentially fatal side effects. And just as the field of medicine is ever changing, so are all the fields that support it.
For example, the Agency for Healthcare Research and Qualify (AHRQ) has developed the Re-Engineered Discharge (RED) tool kit , which has been highly successful in reducing hospital readmissions. Originally developed by a group of AHRQ-funded researchers in Boston, RED provides evidence-based tools that help hospitals re-engineer their discharge process. One success story – within 3 months of implementing RED, the Valley Baptist Medical Center in Harlingen, Tex., decreased readmissions from 26% to 15%.
The RED model focuses on comprehensive discharge planning, educating patients about their discharge, and postdischarge follow-up care. It uses dedicated discharge advocates to help patients reconcile their medications and schedule much-needed follow-up appointments.
Other models exist as well. For instance, some hospitals have a palliative care team that focuses not only on keeping patients comfortable while in the hospital, but also on helping them access community services after discharge and make necessary appointments, geared at optimizing their health and ultimately decreasing the need for excessive hospitalizations.
As every health care dollar spent will be scrutinized more and more over time, innovative programs to help us rethink our long-established routines will likely play a major role in catapulting us from where we are to where we want to be.
Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com .
