Brown University School of Public Health researchers Dr. Rosa Baier, Associate Director of the Center for Long-Term Care Quality & Innovation, and Dr. Amal Trivedi, Associate Professor of Health Services, Policy and Practice, report transitional care is one area of broad debate about how to characterize problems and intervene. Because returning to the hospital following discharge is common, costly, and burdensome to patients and their caregivers, reducing readmission rates has emerged as an important quality goal. As a result, Medicare and other insurers are using readmission as a marker of poor quality care and financially penalizing hospitals (and soon nursing homes) for “higher than expected” 30-day readmission rates. This makes it increasingly pressing to identify effective strategies to prevent readmissions.
[Photo: Dr. Rosa Baier]
Recent evidence has documented national readmission rates are declining, though the precise mechanisms remain unclear. Although there are many well-known readmissions reduction programs, systematic reviews demonstrate programs’ variable success and highlight the need for additional research to characterize the components of successful interventions.
Implementing effective interventions to reduce readmissions is deceptively difficult. Numerous barriers affect patients’ post-hospital care transitions and contribute to readmissions. Any single barrier can result from multiple root causes, each of which could be targeted for intervention. In light of this complexity, how can we implement systems change that improves communication and coordination for all patients, at all points in the care continuum? And how can we target or tailor assistance to those at highest risk?
The researchers discuss the results of a study by Herzig et al. that asked primary care physicians, admitting physicians, and discharging physicians to identify factors contributing to specific patients’ readmissions and strategies to prevent readmissions. All three groups cited patient- (as opposed to physician- or system-) related factors with the greatest frequency, suggesting a need to identify interventions aimed at empowering and activating patients and caregivers during the chaotic time immediately following a hospital stay. While the study surveyed physicians with multiple perspectives, it omitted one important voice: the patient’s. Patients and caregivers can share valuable information about the factors contributing to their readmissions and the strategies they believe would be effective.
How can we improve readmissions without agreeing on the contributing factors? The study by Herzig et al. demonstrates that primary care physicians, admitting, and discharging physicians all have important, but diverse and divergent, perspectives about the reasons for readmissions. The researchers recommend enhancing communication among these providers and their patients to improve care transitions and outcomes following a hospitalization. Open dialogue is needed to arrive at consensus about establishing expectations, prioritizing interventions, and obtaining buy-in for implementation.
This report was published in the Journal of General Internal Medicine, August 2016.