Wasted Effort?


A research team reports in the Annals of Internal Medicine (2011;155:520-528) that of the 43 recent English-language studies of care-transition strategies they reviewed, none was associated with a reduced risk for 30-day rehospitalization.

The team, from Northwestern Feinberg School of Medicine in Chicago, defined 12 distinct activities done before, after, and during hospital discharge to reduce readmissions. The activities might be familiar to hospitalists who follow this subject, such as medication reconciliation, scheduling of follow-up appointments before discharge, placing follow-up phone calls, and the use of transitions coaches.

As with many such reviews, the Annals article leaves open the question of whether this negative finding reflects limitations in the research literature, "or does it reflect an absolute truth about care-transitions strategies?" says lead author Luke Hansen, MD, MHS. "So you have to make inferences. But we clearly don't have a strong research base."

The study is timely, as many HM groups are preparing for a Medicare policy to start in October 2012 that would penalize hospitals with higher-than-expected readmission rates.

"Hospitals have to change, but unfortunately they'll have to do it without a lot of evidence," Dr. Hansen says. "You probably will have to bundle several strategies together, and the more components you include, the more likely you are to achieve the needed cultural change."

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