By Chris Kaiser, Cardiology Editor, MedPage Today
- Having nurses supervise medication plans
- Scheduling follow-up appointments before patients leave the hospital
- Collaborating with other hospitals to develop consistent strategies for reducing readmission
- Developing systems to forward discharge information to the patient’s primary care doctor
- Contacting patients on all test results received after they are discharged
- Forming partnerships with community physicians or physician groups
One of the problems, researchers discovered, was that fewer than 30% of the hospitals surveyed followed most of the steps, and only 7% used all six. To identify the six strategies, Bradley and colleagues sent a web-based survey between November 2010 and May 2011 to 658 hospitals that were enrolled in one or both of two national quality initiatives to reduce heart failure readmissions. A total of 599 hospitals completed the survey, and 14 hospitals were excluded for missing RSRR data. The remaining 585 hospitals comprised the cross-sectional study. Investigators found a mean readmission rate of 24.7%. In the multivariable analysis, they adjusted for the number of staffed beds, teaching status, and census region. Unexpectedly, researchers also found some strategies associated with an increase in RSRR, even though they have been recommended by quality alliances. They include:
- More frequent electronic linking of outpatient and inpatient prescription records
- Providing all patients or their caregivers with a written emergency plan upon discharge
- Having a reliable process to ensure outpatient physicians were alerted about the patient’s discharge within 48 hours after discharge
A number of reasons could explain this increase in RSRR including variable quality of implementation or a measurement of the strategy that is imperfect, Bradley and colleagues said. There may be some strategies that were not significant in this national sample, but may be effective in individual hospitals and “tailoring strategies to fit local circumstances should be encouraged,” researchers noted. The study was limited by its cross-sectional design, the lack of data on how hospitals implemented the strategies, no data on patient socioeconomic status, self-selection bias, and no information on organizational culture, according to the researchers.
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