Sumanta Chaudhuri Saini Vipul Rana Bipin Thapa Adil Jadoon Binod Dhakal Ritesh Panwar

1. Review of individual readmissions by hospitalists: Preliminary findings of a quality improvement project Sumanta Chaudhuri Saini Vipul Rana BipinThapa Adil Jadoon Binod Dhakal Ritesh Panwar Kathleen Idstein Mary Conti KartikReddy Siddhartha Singh 

2. OUTLINE • The Readmissions Problem • Our Project Goals • Conceptual Basis of Our project • Project Timeline and Process • Preliminary Findings

3. Readmissions: A National Problem An Expensive Issue Readmissions accounted for $17.4 billion of the $102.6 billion total hospital payments made by Medicare Reimbursement methods are changing to address readmissions A Common Issue

4. Readmissions: A Local Problem Froedtert Hospital ranked 107th out of 113 academic medical centers Data from University Healthsystems Consortium

5. The Goals of the Hospitalist Readmissions Project • Understand reasons for our high readmission rates • Change key processes and systems in our hospital medicine practice • Improve readmission rates

6. The ‘Hospitalist Readmissions Project’ Conceptual Model OUTCOME SELECTION CHANGE SYSTEMS AND PROCESSES Measurement Knowledge about PERFORMANCE Knowledge about PROCESS Motivation Care Delivery Teams & Practitioners Consumers Adapted from: Berwick, James and Coye (2003)

7. Process and Timeline KICKOFF MEETING NARRATIVE REVIEWS INITIATED OCT 2010 JAN 2011 MAR 2011 CORE GROUP REVIEWS READMISSIONS READMISSIONS TOOL IMPLEMENTED MONTHLY MEETINGS BEGUN

8. Monthly Meeting Format • Review • trends in section readmission rates • case review completion rates • suggestions for improving tool • select literature on readmissions • Highlight individuals with lowest readmission rates in the last month • Discuss 3 readmission cases • Analysis of process errors and systems break-down with group input

9. Standardized Data Abstraction Tool

10. Lessons Learned • Individual learning • Group learning • Standardization of hospitalist practice • System changes impacting section of hospital medicine Next Steps • System changes impacting hospital and medical group practice • Search for positive deviance • Survey hospitalists for their perception of changes

11. Results: Case review completion rates 670/1210 55% completion Individual Hospitalists

12. How many readmissions are preventable? 39%

13. Preventable Readmissions by Category

14. Early Impact on Readmissions

15. In Summary • Readmissions are complex phenomena that may be resistant to traditional improvement methods • Case review of each readmission by discharging physician is feasible • This will lead to learning and system change that improves readmission rates

16. Special Thanks • Janice Lewis • Lee Biblo, MD • Beth Vrba

17. Healthcare system factors • Healthcare system factors • Inpatient: Readmission occured as a result of an error or oversight* during index admission/discharge • Outpatient: Readmission occured as a result of an error or oversight* during outpatient care, including subspecialty care • ED: Readmission occured as a result of an error or oversight* during emergency room care, including index admission and/or readmission • Non-Acute Facility: Readmission occurred as a result of an error or oversight* during care in an outpatient facility, such as a SNF or rehabilitation facility *including a health care provider’s lack of understanding of disease process or underestimation of disease severity