The author of a new study that shows 20% of Medicare patient discharges are readmitted within 30 days thinks hospitalists can—and should—take a lead role in reducing those rates by improving patient transitions from hospital to home.
The study, released today in the New England Journal of Medicine, also shows that half of nonsurgical patients are readmitted to the hospital without seeing an outpatient doctor, and the unplanned rehospitalizations cost Medicare $17.4 billion in 2004.
“This is not a problem that is limited to the elderly. Going home after being in the hospital is scary,” says Stephen Jencks, MD, MPh, a psychiatrist who worked for the Centers for Medicare & Medicaid Services for more than 20 years. “We need to treat that transition as being as dangerous as going through the operating room.”
Dr. Jencks thinks HM, because of its full-time presence in hospitals, is positioned to make a difference by working with all levels of hospital staff and maintaining relationships with primary-care physicians.
“Hospitalists should say: We are in the middle of this; we are in a position to do this; and if we don’t, a lot of people will continue to get hurt,” Dr. Jencks says. “I think if they can make the re-hospitalization problem better, they will have a real feather in their cap.”
Researchers found most patients were rehospitalized for conditions other than those they were originally hospitalized for but might have been controlled prior to discharge. Rehospitalization rates varied widely by state: Maryland, New Jersey, Louisiana, Illinois, and Mississippi had rates 45% higher than Idaho, Utah, Oregon, Colorado, and New Mexico.
Study co-author Mark Williams, MD, a professor in the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, also is leader of SHM’s transitional care mentoring program, Project BOOST.
The authors suggest several steps to reduce rehospitalizations: interventions to optimize the discharge process; sharing readmission information between hospitals; and physician collaboration to ensure follow-up care.