Many hospitals not taking steps to reduce readmissions

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Although hospitals have financial motivation to lower their readmission rates, many have not taken the recommended steps that could reduce those rates, according to a research letter published online Oct. 21 in JAMA Internal Medicine.

“[M]any hospitals have enrolled in quality collaboratives or campaigns to implement evidence-based strategies to reduce readmission rates,” wrote the authors, led by Elizabeth H. Bradley, PhD, of the Yale School of Public Health in New Haven, Conn. “However, we have little information on the changes in practice ... among the nation’s hospitals.”

Using data from the Hospital to Home Quality Improvement Initiative, an American College of Cardiology and Institute of Healthcare Improvement campaign to reduce hospital readmissions among patients with cardiovascular disease, researchers analyzed changes in 437 participating hospitals’ use of recommended strategies between 2010 and 2012.  

There was a significant increase in the use of some of the strategies as indicated by surveys at the start of the study and approximately 12 to 18 months later. More hospitals were working with other local hospitals to reduce readmissions (30.7 percent at baseline vs 22.9 percent at follow-up), making follow-up appointments before discharge (61.1 percent vs 52.4 percent) and monitoring the percentage of patients discharged with appointments within one week (43 percent vs 32.2 percent) as well as patients readmitted to other hospitals (19 percent vs 12 percent).

More hospitals were also formally estimating readmission risk (34.6 percent vs 22.5 percent), reconciling medications electronically  (81 percent vs 72.8 percent) and educating patients through the use of return demonstration techniques (80.8 percent vs 68.9 percent). Hospitals were also using discharge plans for heart failure significantly more often (60 percent vs 52.2 percent) and calling patients after discharge to ask about any needs or educate further (71.4 percent vs 62.9 percent).

However, the use of other recommended strategies did not significantly change. Fewer than 40 percent of hospitals had a system for informing outpatient providers about discharges within 48 hours or for following up on test results received after discharge. Additionally, less than 25 percent of hospitals always sent the primary care provider a discharge summary and less than 67 percent always had nurses report to other nurses before discharging to nursing homes.

Their findings, the authors wrote, help explain why readmission rates are slow to improve.

“More consistently implemented strategies to promote safe transitions from hospital to home are likely critical for reducing readmission rates in the years ahead.”