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Public Reporting of Discharge Planning Challenged


 

A recent article in the New England Journal of Medicine (2009;361:2637-2645) questions whether improved planning for hospital discharges decreases readmission rates.

Ashish Jha, MD, MPH, of the Harvard School of Public Health and colleagues examined two publicly reported discharge-planning quality measures from the Centers for Medicare and Medicaid Services’ (CMS) Hospital Quality Alliance. The measures focus on documentation that discharge instructions were provided to patients with congestive heart failure and patients’ self-reported experience with discharge planning.

The researchers found no correlation with rates of readmission for congestive heart failure and pneumonia, and only weak correlation between the two quality measures. Based on their findings, the team concluded that public reporting of quality-related discharge-planning measures is unlikely to yield significant reductions in rehospitalization rates.

A number of national initiatives, including SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), are focused on improving hospital discharge planning processes and care transitions, which are significant themes in the national health reform debate.

But the NEJM results should not be surprising, says Arpana Vidyarthi, MD, hospitalist and director of quality at the University of California at San Francisco. “Discharge planning is not a five-minute thing you do on the day of discharge. Improving the discharge process actually starts on the day of hospital admission. It is a complex problem and it needs multifaceted, evidence-based solutions,” including process evaluations by hospital teams and the application of supporting communications technology.

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