Good strategies, poor execution?

In the technology world, a stellar innovation poorly launched into the marketplace faces an uphill battle. The same may be true for interventions designed to reduce heart failure readmissions.

This week Elizabeth H. Bradley, PhD, of the Yale School of Public Health in New Haven, Conn., and her team published results from their latest work on 30-day readmissions. They listed six strategies that, based on data from a national survey, showed a reduction in the rate of 30-day readmissions for heart failure. Implementing the six strategies together could lead to a rate reduction of two percentage points.

Two percentage points could pull hospitals that teeter on the brink of a penalty under Medicare’s Hospital Readmissions Reduction Program back into the rewards side and maybe save some that already have had payments withheld from experiencing another round of penalties. More importantly, the reduction should translate into cost savings and better care.

Four strategies also increased readmission rates, a finding that Bradley said surprised the researchers. They offered several possible explanations. Bradley emphasized the need to have a robust primary care system in place to support discharged patients and strong communications and partnerships with community physicians, physician groups and local hospitals.  

But some hospitals also may fall short in execution. If a strategy is not properly implemented, can it provide the intended benefits?  

Bradley and her team have been building the foundation for research to better understand modifiable practices in hospitals that may affect the quality of care for heart failure and acute MI patients. In the meantime, policy makers move ahead with their readmissions reduction initiative, which is set to expand beyond penalties for heart failure, acute MI and pneumonia to include CABG and PCI.

Understanding the drivers of readmissions and patient outcomes appears to be lagging. The work of Bradley’s group and others will help elucidate this complex challenge. For now, what resource is your hospital using to navigate the unknown?

Candace Stuart

Cardiovascular Business, editor