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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

READMISSIONS: How to reduce bounce back from SNFs

After an inpatient stay in the hospital, some patients are discharged to skilled nursing facilities (SNFs) for continued recuperation and therapy.  This article summarizes the findings of a literature search of studies on how to avoid bounce back – readmission of these patients from the SNF to the hospital within 30 days.  Learnings about barriers and strategies from the 10 studies are compared in this article.

Source: Mileski, M., and others. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222. Click here for free full text: https://www.dovepress.com/getfile.php?fileID=34598.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Community health workers help reduce

A readmission reduction program established by the University of Maryland St. Joseph Medical Center (Towson, Md.) in partnership with Maxim Healthcare is described in this brief article.  Prior to establishment of this home-based service, the hospital had 30-day readmission rates of 25 percent for high risk patients – which dropped to 10 percent about a year or so later.  It is staffed by nurse practitioners, RNs, and community health workers – who are considered key to the success of the program.

Planning Statistics: Program Experience (based on first 17 months)

  • 1600 assessments of high risk patients
  • 1200 of those patients agreed to participate in the program
  • 5 percent of hospital’s total discharges opt into the program
  • 15 community health workers were employed to care for the 1200 patients

Source: Whitman, E. (2016, Oct. 24). Deploying community health workers to reduce readmission rates. Modern Healthcare, 46(43), 32.  Click here for article published in slightly different version: http://www.modernhealthcare.com/article/20161022/magazine/310229996   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HIP FRACTURES: Patient characteristics, outcomes, surgical volume: Data from Kaiser Permanente registry

What are the outcomes for patients who have had surgery after breaking a hip?  This is a study of the Kaiser Permanente Hip Fracture Registry – looking at over 12,000 patients in California in 2009 through 2011.  The registry data includes 33 medical centers and 474 surgeons.  Here is a look at this data-rich article:

Characteristics of Patients with Broken Hips

  • Two-thirds are female
  • Two-thirds are 75 years or older
  • Over half have 3 or more other medical problems (comorbidities)
  • Two-thirds have hypertension

Patient Outcomes

  • 4-day length of stay (median)
  • 6.2 percent death within 30 days
  • 12.3 percent death within 90 days
  • 12.2 percent readmission within 30 days
  • 22.1 percent readmission within 90 days
  • 11.4 percent contracted pneumonia
  •   1.1 percent surgical site infection

Surgeon Characteristics

  • 12.1 percent low volume (less than 10 procedures / year)
  • 68.4 percent medium volume (10 to 29 procedures / year)
  • 19.5 percent high volume (30+ procedures / year)

Hospital Characteristics

  •   1.7 percent low volume (less than 60 procedures / year)
  • 35.3 percent medium volume (60 to 129 procedures / year)
  • 63.0 percent high volume (130+ procedures / year)

Source: Inacio, M.C.S., and others. (2015, Sum.). A community-based hip fracture registry: Population, methods, and outcomes. The Permanente Journal, 19(3), 29-36.  Click here for free full text: http://www.thepermanentejournal.org/files/Summer2015/Registry.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: What is a transitional care bundle?

Kaiser Permanente Northwest (Portland, Ore.) developed a transitional care bundle in 2009 intended to assist patients on discharge from hospital to home.  The initial results of implementation of this approach are reported in this study.  Hospital inpatients are assigned a risk level – high, medium, or low – and then receive different level of support services.  The services include:

  • Telephone hotline number
  • Same-day standardized discharge summaries and discharge instructions
  • Post-hospital follow-up – 5 days for high risk and longer for lower risk patients
  • Medication reconciliation

In the 269-bed hospital that was studied, about half of all patients discharged from hospital to home were judged to be high risk.  In the 5 years studied, the readmission rate was cut from 12.1 percent to 10.6 percent.

Source: Rice, Y.B., and others. (2016, Feb.). Tackling 30-day, all-cause readmissions with a patient-centered transitional care bundle. Population Health Management, 19(1), 56-62.  Click here: http://online.liebertpub.com/doi/pdf/10.1089/pop.2014.0163

Related news item: Erich, J. (2015, July 1). Kaiser Permanente’s plan to prevent readmissions. IH Executive. Click here: http://www.ihexecutive.com/patient-care/clinical-pathways/article/12076292/kaiser-permanentes-plan-to-prevent-readmissions  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Top 10 most frequent DRGs for 30-day hospital readmissions, U.S. 2013

These are data collected by the federal government – the Agency for Healthcare Research and Quality – as part of the Healthcare Cost and Utilization Project (HCUP) Nationside Readmissions Database, 2013.  This is a free database – our tax dollars spent for interesting national data.

Top 10 DRGs by NUMBER of 30-Day Readmissions
[Note: The DRG official names are longer – explicitly including or excluding complications and comorbidities, for example.  I’ve shortened the names below.  Please see the source for the full condition names.

  • 184,730  DRG 885: Psychoses
  • 113,376  DRG 871: Septicemia
  •   96,130  DRG 392: Esophagitis
  •   79,908  DRG 292: Heart failure (with complications or comorbidities)
  •   69,847  DRG 291: Heart failure (with major complications or comorbidities)
  •   62,852  DRG 847: Chemotherapy without acute leukemia as secondary diagnosis
  •   54,304  DRG 812: Red blood cell disorders
  •   53,224  DRG 683: Renal failure
  •   51,039  DRG 194: Simple pneumonia & pleurisy
  •   50,719  DRG 190: Chronic obstructive pulmonary disease

Top 10 DRGs by PERCENT of Cases That Are 30-Day Readmissions

  • 86 percent  DRG 780: False labor
  • 72 percent  DRG 839: One of the chemotherapy DRGs
  • 70 percent  DRG 847: Another of the chemo DRGs
  • 67 percent  DRG 838: Another of the chemo DRGs
  • 67 percent  DRG 846: Another of the chemo DRGs
  • 67 percent DRG  848: Another of the chemo DRGs
  • 51 percent  DRG 778: Threatened abortion
  • 49 percent  DRG 834: One of the acute leukemia DRGs
  • 46 percent  DRG 835: Another of the acute leukemia DRGs
  • 36 percent  DRG 840: Lymphoma and non-acute leukemia

Source: U.S. Agency for Healthcare Quality and Research. All patient readmissions within 30 days: National statistics, 2013.  Click here: http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=4955DDB08ECF260B&Form=SelDXPR&JS=Y&Action=%3E%3ENext%3E%3E&_DXPR=PreRunDRG   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: What factors influence 30-day pneumonia readmission rate?

Factors associated with either increasing or decreasing the rate of 30-day readmissions for pneumonia patients were studied based on data from 577 hospitals in California, Massachusetts, and New York.  Among the factors that were found to be associated with a lower readmission rate were being hospitalized in California; supplying the patient with instructions about recovering at home; and, hospitalist and RN hours per patient day, among others.  The authors draw conclusions related to the value of nurse staffing, communication, and responsiveness in reducing 30-day readmission rates for pneumonia.

Source: Flanagan, J., and Stamp, K.D. (2016, Feb.). Predictors of 30-day readmission for pneumonia. JONA. The Journal of Nursing Administration. 46(2), 69-74.  Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2016/02000/Predictors_of_30_Day_Readmission_for_Pneumonia.5.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org