7A Improving Patient Outcomes by Decreasing Patient Readmission Rates

1. 7A Improving Patient Outcomes by Decreasing Patient Readmission Rates Authors: (Marlena Didonoato) Karen Eggers, 7A staff , Dr Rhode, Donna Mcclish, Deby Evans, Winnie Wood, Medicine Hospitalist Service, Gail Sinwell, and the Transition of Care Project Team. University of Michigan Hospital and Health Centers, Ann Arbor, Michigan Implementation Strategies Purpose Significance • Interventions are put in place to mitigate the risks for readmission as much as possible. • Interventions include using the teach-back process during patient education (having the patient repeat information and education in their own words). • Early referrals based on the patients responses to questions asked upon admission. • Answering “yes” to unexplained weight loss, non healing wounds, would trigger a nutrition referral. • Answering “yes” to having financial concerns or having been admitted within the last 30 days would trigger a social work or discharge planner referral. • Unit Champions provided staff education regarding: • Impact of avoidable readmissions • Importance of decreasing/preventing readmissions • All aspects of the risk assessment form (risks and interventions) • When and how to place relevant referrals • Teach-back process • Staff viewed teach back videos • Staff observed and evaluated each other performing teach-back The goal of Transitions of Care is to prevent or decrease avoidable patient readmissions to the hospital within 30 days of discharge and to improve transfer of information to discharge providers • The hospital readmission rate for 2009 was 15.44%. • In July 2010 the pilot on 7A was implemented and for 2010 the readmission rate decreased to 15.39%. • The TOC program has now been implemented on two other units within the hospital (5B and 4A) and as of February 2011 the mean readmission rate was 14.14%. Synthesis The Medicare Payment Advisory Commission (MedPAC) reported “18% of Medicare hospital admissions result in readmissions within 30 days of discharge, accounting for $15 billion in spending.” Centers for Medicare and Medicaid Services have proposed to adjust reimbursement rates to institutions in relation to avoidable hospital readmission rates. The University of Michigan Health System is involved with other initiatives and institutions across Michigan to reduce hospital readmissions. Evaluation • The unit receives reports daily with information about patients that have been readmitted within 30 days of discharge from Clinical Information & Decision Support Services (CIDSS). • Reports contain the patients readmission diagnosis, admitting service, previous admission diagnosis and service, number of days since discharge, and discharge disposition. • The readmission diagnoses varied. Patient that were readmitted with the same diagnosis were due to exacerbations but >85% were due to an unrelated diagnosis • According to current data from CIDSS, readmission rate were 23.21% in July 2010 and 14.56% as in April 2011 (number of monthly discharges ranged from 168 to 142). References Change In July 2010, unit champions utilized the “Better Outcomes for Older Adults through Safe Transitions” (BOOST) Risk Assessment tool to create an admission check list. RN’s utilize the admission check list to identify Predictors for readmission include problem/high risk medications, depression, polypharmacy, a new diagnosis, poor health literacy, lack of patient support, and prior hospitalization within the last 6 months. Institute for Health Improvements Reducing Readmissions by Improving Transitions of Care http://www.ihi.org/IHI/Programs/Collaboratives/IHICollaborativeIReducingReadmissionsbyImprovingTransitionsinCare.htm Institute for Health Improvements: State Action on Avoidable Rehospitalizations Initiative http://www.ihi.org/IHI/Programs/StrategicInitiatives/StateActiononAvoidableRehospitalizationsSTAAR.htm MedPac:Reforming Americas Healthcare Delivery System, April 21, 2009 (p5) http://www.medpac.gov/documents/Hackbarth%20Statement%20SFC%20Roundtable%204%2021%20FINAL%20with%20header%20and%20footer.pdf