Members ask: To reduce readmissions, is a disease-specific approach best?

We want to avoid rising Medicare penalties for high readmission rates. Would focusing on discharge processes for some of the biggest drivers of high readmission rates—heart failure and pneumonia—offer the best return?

The Daily Briefing team took this question to our experts, who caution against a condition-specific approach to readmissions reduction.

Here's why: While the top two conditions are a smart place to start, combined they only account for 15% of all readmissions. Even if you include the next two most frequently re-hospitalized conditions—psychoses and COPD—they will target patients with conditions accounting for only about 24% of readmissions.

Put simply, a disease-specific approach is unlikely to impact the majority of patients at risk for re-hospitalization. Instead, our experts from the Nursing Executive Center (NEC) recommend a three-part readmission prevention strategy:

  1. Expand efforts to prevent readmissions beyond a disease-specific approach and focus on all patients at risk for readmission, regardless of condition.
  2. Ensure interventions are narrowly focused on specific drivers of potentially preventable readmissions and not "all-cause" readmissions that are beyond a hospital's control.
  3. Strengthen coordination of care within and across multiple settings to ensure patients receive appropriate care across the continuum.

That strategy is detailed in the Nursing Executive Center's study Nurse-Led Strategies for Preventing Avoidable Readmissions. And our experts say it can help uncover institution-specific root causes of patient readmissions and help develop corresponding interventions. For example, they cite the case of the Cleveland Clinic, which found that surfacing and addressing operational shortfalls helped reduce the readmissions rate by five to eight percentage points in certain units.

Our experts from the Nursing Executive Center also offer two other practices from the study Achieving Top-of-License Nursing Practice that speak to better preparing patients for discharge in order to avoid readmissions:

  • Practice #1: Unified Care Plan Development details the use of collaborative, three-person nurse, physician, and pharmacist teams to develop a plan of care with specific discharge milestones that patients must meet. The trio consults with the case manager during daily rounds if the patient is not progressing as expected.
  • Practice #2: Skilled Nursing Facility Transfer Expert outlines the post-acute care manager (PACM) role employed at Oregon Health & Science University to ensure safe patient transitions to the post-acute setting. The PACM meets with hospital case managers to discuss difficult-to-place patients.

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