A Requirement to Reduce Readmissions Take Care of the Patient, Not Just the Disease

JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2013; 309(4):394-6. DOI: 10.1001/jama.2012.233964
Source: PubMed
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    • "Recent studies have found that lack of primary care follow-up within seven days of discharge increases risk of 30- day readmission tenfold (Hernandez et al., 2010; Takahashi et al., 2013). Other issues at discharge include lack of communication with the primary care physician (PCP) at discharge, a decreasing number of available PCPs (Williams, 2013), inadequate or nonexistent medication reconciliation (Boling, 2009), incomplete or inaccurate information transfer to the next provider (Boling, 2009; Williams, 2013), and patient non-compliance with prescribed medications (Boling, 2009). These issues can lead to inadequate patient and caregiver preparation for quality care at the next health location (Coleman et al., 2004; Coleman, Parry, Chalmers, Chugh, & Mahoney, 2007) lack of preparation for self-management role, lack of access to a health care practitioner to address direct concerns, and minimal input in patient care plans (Institute of Medicine Staff, 2006). "
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    ABSTRACT: High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.
    Social Work in Health Care 03/2015; 54(3):177-92. DOI:10.1080/00981389.2015.1005273 · 0.62 Impact Factor
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    • "Due to high rates of 30-day readmissions for US Medicare beneficiaries, the Patient Protection and Affordable Care Act of 2010 authorized the CMS to reduce payments to hospitals with higher than expected 30-day readmission rates for select conditions.11,12 Currently, heart failure, acute myocardial infarction, and pneumonia are targeted,13 but beginning in the fall of 2014, COPD will be added to the list of conditions.11,12 "
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    ABSTRACT: Inpatient admissions for chronic obstructive pulmonary disease (COPD) represent a significant economic burden, accounting for over half of direct medical costs. Reducing 30-day readmissions could save health care resources while improving patient care. Recently, the Patient Protection and Affordable Care Act authorized reduced Medicare payments to hospitals with excess readmissions for acute myocardial infarction, heart failure, and pneumonia. Starting in October 2014, hospitals will also be penalized for excess COPD readmissions. This retrospective database study investigated whether use of arformoterol, a nebulized long-acting beta agonist, during an inpatient admission, had different 30-day all-cause readmission rates compared with treatment using nebulized short-acting beta agonists (SABAs, albuterol, or levalbuterol). A US nationally representative hospital database was used to study adults aged ≥40 years, discharged between January, 2006 and March, 2010, and with a diagnosis of COPD. Patients receiving arformoterol on ≥80% of days following treatment initiation were compared with patients receiving a nebulized SABA during hospitalization. Arformoterol and nebulized SABA patients were matched (1:2) for age, sex, severity of inpatient admission, and primary/secondary COPD diagnosis. Logistic regression compared the odds of readmission while adjusting for age, sex, race, admission type, severity, primary/secondary diagnosis, other respiratory medication use, respiratory therapy use, oxygen use, hospital size, and teaching status. This retrospective study compared 812 arformoterol patients and 1,651 nebulized SABA patients who were discharged from their initial COPD hospital admission. An intensive care unit stay was more common among arformoterol patients (32.1% versus 18.4%, P<0.001), suggesting more severe symptoms during the initial admission. The observed readmission rate was significantly lower for arformoterol patients than for nebulized SABA patients (8.7% versus 11.9%, P=0.017), as were the adjusted odds of readmission (odds ratio 0.69, 95% confidence interval 0.51-0.92). All-cause 30-day readmission rates were significantly lower for arformoterol patients than nebulized SABA patients, both before and after adjusting for patient and hospital characteristics.
    International Journal of COPD 12/2013; 8:631-9. DOI:10.2147/COPD.S52557 · 3.14 Impact Factor
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    • "The inclusion of the Hospital Readmission Reduction Program (HRRP) in the Affordable Care Act represents a movement toward high powered incentives to reduce hospital readmission. This has spurred a concomitant rise in research interest on this topic (Kangovi and Grande, 2011; Joynt and Jha, 2013; Williams, 2013). "
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    ABSTRACT: All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.
    Health Economics Policy and Law 08/2013; 9(2):1-21. DOI:10.1017/S1744133113000340 · 1.33 Impact Factor
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