Confronting Patient Readmission Rates Creatively and Sensibly

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Kaiser Health News (in collaboration with The New York Times) reports on the many creative and sensible ways in which hospitals are working to prevent patient readmissions, especially with Medicare giving increased scrutiny and heftier financial penalties to organizations with high readmission rates.

As Jordan Rau reports, “…hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications, and even bathroom scales to patients deemed at risk of relapsing.”

Maintaining a certain level of distrust toward patients taking care of themselves upon being discharged seems to be at least one of the keys to these programs, and that distrust is not without justification. Hospitals will fill prescriptions, schedule follow-up appointments, and micromanage care at nursing homes to make sure patients don’t return.

Home visits are not unusual either. Robert Wood Johnson University Hospital in New Brunswick, N.J., will send nurses to homes to clean out medicine cabinets and schedule dosages for high-risk patients within two days of that patient being discharged. This is not paranoia on the part of the healthcare organization. It’s a legitimate concern.

As Rau reports, “A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.”

Most patients couldn’t regurgitate basic details about their medication and prescriptions to researchers. Most patients aren’t aware enough of their own health to recognize when there are problems. That’s why Arizona’s Sun Health Care Transitions provides scales for congestive heart-failure patients, so they can log their weight daily to make sure there is no water retention.

But are these measures enough? Certainly these systems have reported changes for the better in readmission rates. However, one critic—Denver geriatrician Dr. Eric Coleman—cynically calls some methods “relabeling old wine in new bottles. Yesterday we had ‘discharge planning’ and today we have a ‘rapid response transition team,’ and content-wise they’re doing the same thing.

“But it’s a nice thing to report out to the board of trustees.”

What do you think? How is your system trying to reduce patient readmission rates? Are these methods new approaches to an old problem or old solutions with new labels, as Dr. Coleman charges? We’d love to read your input and what initiatives your organization is taking to confront the readmissions issue.

-by Pete Fernbaugh

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{ 1 comment… read it below or add one }

Dolores A. Griffin November 5, 2013 at 6:01 pm

I love the information that I would normally not be able to receive.
Thank you,
Dolores Griffind


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