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July 18, 2013

Six evidence-based strategies to reduce readmissions

Daily Briefing

    Researchers from Yale University have identified six strategies that could help U.S. hospitals reduce 30-day Medicare readmissions by 2%—and they argue that nationwide adoption of the strategies would put a dent in the nation's annual $15 billion readmissions bill.

    For the study—which was published in Circulation: Cardiovascular Quality and Outcomes—researchers studied data from a 2010-2011 online survey of 585 hospitals involved in a national quality initiative to reduce heart failure readmissions. Using the surveys, the researchers identified six strategies that hospitals could deploy to reduce their readmissions, including:

    • Partnering with local physicians and physician groups;
    • Collaborating with local facilities to develop consistent readmission reducing strategies;
    • Assigning nurses to manage medication plans;
    • Scheduling follow-up appointments for patients pre-discharge;
    • Following up with patients post-discharge with test results; and
    • Developing a post-discharge plan with the patient's primary physicians and sharing medical records with the physician.

    Lead author Elizabeth Bradley told MedPage Today that she hoped the study would help health care officials realize that reducing readmission rates is a system-wide problem.

    "It is not something one physician or one nurse can do," Bradley said, adding that "[i]t requires engagement of a full clinical discharge team, excellent practices of follow-up, and full engagement with the patient and family."

    Opposing view: Readmissions problem too pervasive for strategies to accomplish much

    However, at least one critic was skeptical that the strategies would lead to significant change.

    According to Clyde Yancy of the Northwestern University Feinberg School of Medicine—who was not involved in the study—hospitals that choose to pursue "one or more of these meager six steps, [have] at best the hope for a modest impact."

    "The larger message of a dysfunctional system cannot be ignored," he added.

    Yancy suggested that the strategies may need to be changed should the Medicare Physician Advisory Committee's recently released recommendations to change the Medicare program be adopted.

    "The change would eliminate the current disease-specific model and focus on all readmissions. Hospitals could then use more resources on process issues and fewer futile efforts on already overburdened heart failure patients," Yancy told MedPage Today (New Haven Register, 7/16; Kaiser, MedPage Today, 7/16).

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