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Tackling Readmissions Together


 

A new report in the Journal of Hospital Medicine suggests that more than 60% of 30-day readmissions are viewed as potentially preventable by hospitalists.

The study, “Hospitalists Assess the Causes of Early Hospital Readmissions,” found that of 298 cases reviewed, 15% were deemed “preventable” by a team of 17 hospitalist reviewers at Providence Health & Services in Portland, Ore. (DOI: 10.1002/jhm.909). Another 40% were tagged as “possibly preventable,” the authors reported.

When the reviewers analyzed cases to determine what interventions could have prevented readmissions, team-based approaches were the answer much of the time, says lead author and hospitalist Douglas Koekkoek, MD. Those potential answers included earlier follow-up conversations with primary-care physicians (PCPs), palliative care-consults, and more education about home-care management.

“When a physician looks at just his locus of control, they tend to be a little pessimistic,” Dr. Koekkoek says. “When they take a systems approach ... then they gain that optimism.”

The report found that in 23% of the cases, hospitalists found that extending length of stay by a day or two could have prevented a readmission. Dr. Koekkoek says that inherent conflict?balancing the cost of every hospitalized day against keeping patients long enough to prevent readmission?is “the bread and butter of hospitalist care.”

“There is going to be a natural conflict of ‘I can’t keep people in the hospital forever,’” he adds.

Given that the federal government is likely to start reducing reimbursements for unnecessary readmissions, Dr. Koekkoek says HM groups have to view their work as one front in the battle to keep patients from returning. And that has to include outpatient physicians, patient education, and other techniques.

“The take-home is we are part of a care team,” he adds. “And the team extends beyond the hospital’s walls.”

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