The 30-day avoidable readmission rate, that is, the rate at which patients are readmitted to a hospital for the same or related medical condition within 30 days, has become a crucial metric for hospital performance. Lower 30-day readmission rates reflect better care than higher rates, and as of 2016, hospitals that have readmission rates higher than a threshold set by the Hospital Readmissions Reduction Program face penalties. Despite this, only about 25 percent of hospitals in the United States have rates low enough to avoid these penalties.
Hospitals are thus interested in reducing their readmission rates and a significant amount of research has investigated different methods for doing this; however, no study has compared and analyzed different interventions to find the most effective aspects of each method, which would enable hospitals to put together an optimal readmission reduction program. To fill that void, Dr. Bita Kash, professor at Texas A&M School of Public Health, led a study with a team of scientists from Houston Methodist and Baylor College of Medicine that investigated various admissions reduction interventions and provided a summary of the top five strategies, with the goal of informing hospital administrators and policymakers.
The study, published in the Journal of Hospital Administration, used studies on hospital readmission reduction interventions published between 2006 and 2017, which the research team then analyzed to find the most impactful and effective interventions. Dr. Kash and colleagues examined hospital type; disease type; intervention timing, type and setting; number of key activities in the intervention; and how interventions affected the readmissions rate. They grouped intervention types into 12 categories, such as home visits, education and telephone follow-ups.
Dr. Kash and colleagues analyzed the data using three different statistical methodologies and found that collaboration between hospitals and providers in the community, home visits, telephone follow-ups, patient education and discharge planning had consistent positive effects on 30-day readmission rates. They also found that remote monitoring of patients, use of medical devices and in-hospital units dedicated to post-discharge care had the smallest impact on reduced readmission rates.
“One common factor among the five most effective program types was that the primary driver of the intervention’s success was the patient,” Dr. Kash said. “Although hospitals and providers play a key part in organizing and managing these interventions, patients must take an active role in each one. This type of shared accountability is a key part of modern medical practice.”
These findings are consistent with previous research on effective pre-discharge and post-discharge readmission reduction methods and that show the importance of patient involvement.
The researchers identify a few limitations of their research, such as the types of health care systems analyzed and the fact that they did not focus on implementation cost of interventions. They state that future studies should perform cost benefit analyses and that they are performing follow-up research to compare studies of interventions showing little to no effect or negative effects on readmissions to validate this study’s findings.
“The top five intervention strategies identified all show promise for reducing hospital readmissions and improving care, especially if the strategies are combined in a way that integrates them into the entire continuum of care and emphasizes the importance of provider and patient collaboration,” Dr. Kash said. “Equipped with the results of this study, hospital executives can draw on a reliable set of tools for lowering avoidable readmissions, thus reducing the likelihood of penalties for hospitals and complications for patients.”
[Photo: Dr. Bita Kash]