Transcript Sample Presentation Title

Addressing the Problem of
Hospital Readmissions
Arya Sedehi
HS 8803
Statistics
• Hospitals account for 31% of total
health expenditures
• Medicare Beneficiaries
– 19.6% of patients are readmitted
within 30 days
– Accounts for $15 billion in spending
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Types of Readmissions
Hospital
Readmission
Avoidable
Unavoidable
Planned
Demographic
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Clinical
Characteristics
Operational
Factors
Unplanned
Types of Readmissions (1)
• Avoidable
– Result of medical error, lack of social support or lack of
understanding of discharge instructions
– Shows poor quality of care
• Unavoidable
– Necessary based on diagnosis of patient
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Avoidable Readmissions
• Demographics
• Clinical Characteristics
• Operational Factors
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Avoidable Readmissions (1)
Demographics
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Avoidable Readmissions (2)
Clinical Factors
• Medications
• Comorbidities
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Avoidable Readmissions (3)
Operational Factors
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Hong Kong Case Study
• Causes of Readmissions
14.60%
43.10%
Demographic
Clinical
42.30%
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Operational
Current Proposed Solutions
• During Hospitalization
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Current Proposed Solutions (1)
• At Discharge
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Current Proposed Solutions (2)
• Post-Discharge
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Current Proposed Solutions (3)
• Project BOOST
• Preliminary Results
– Improved St. Mary’s readmission
– Improved patient satisfaction
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Priority-Based Strategies
• Low Effort Strategies
– Implemented with hospital’s existing resources
• Medium Effort Strategies
– May require hospitals to acquire additional resources
• High Effort Strategies
– May necessitate installation of complex and costly
systems
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Priority-Based Strategies (1)
• Case Study
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Multisite randomized controlled study
Coordination of care across multi-disciplinary team
Use of EMRs to support care coordination
Use of Transitional Care Nurse to coordinate care
High Effort
Annual average savings at $4,845 per patient
My Considerations
• Focus on pre-discharge, at-discharge, and postdischarge interactions with patient and caregiver
• Make sure patients adhere to Medicine
Reconciliation
• Utilize IT to track readmissions over time and
create an index
• Change hospital reimbursement depending on
readmission rates
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My Considerations (1)
• RFID Technology
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My Considerations (2)
• Patient and Asset Tracking
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My Considerations (3)
• Benefits of RFID tracking in hospitals
– Improves equipment utilization & reduces losses
– Improves staff productivity and efficiency
– Can reduce medical errors and improve patient care
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Questions?
References
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Allaudeen, Nazima. 2011. “Redefining readmissions risk factors for general medicine patients,” Journal
of Hospital Medicine. 6, 54-60.
Benbassat, J. and M. Taragin. 2000. “Hospital readmissions as a measure of quality of health care,”
Archives of Internal Medicine. 160(8), 1074-1081.
California Health Advocates. 2010. “Creative interventions reduce hospital readmissions for Medicare
beneficiaries.” http://www.cahealthadvocates.org/news/basics/2010/creative.html
Catlin, A. et al. 2008. “National health spending in 2006: A rear of change for prescription drugs,” Health
Affairs, 2714-2729.
Halfon, Patricia. 2002. “Measuring potentially avoidable hospital readmissions,” Journal of Clinical
Epidermiology, 55, 573-587.
Health Research & Educational Trust. 2010. “Health care leader action guide to reduce avoidable
readmissions,”
Minott, Jenny. “Reducing hospital readmissions.” Academy Health. http://www.academyhealth.org
Personal Communication with Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A.
Coleman, M.D., M.P.H., April 2008.
SMM Project BOOST. “Reducing unnecessary readmissions and so much more.” Society of Hospital
Medicine.
Westert, Gert. 2002. “An international study of hospital readmissions and related utilization in Europe
and the USA.” Health Policy, 61, 269-278.