Seven Southern California hospitals participating in the yearlong Readmissions Reduction Collaborative, modeled after Project BOOST and sponsored by SHM and the Hospital Association of Southern California (HASC), reported on their experience at a June meeting in Montebello, Calif. Quality teams from four of the seven hospitals demonstrated reductions in readmission rates ranging from 24% to 55%. The other three hospitals are still implementing quality processes and are just now starting to see measurable results.
Several of the participating hospitals do not employ traditional hospitalist services. However, all seven benefit from mentoring by Project BOOST experts and have adopted a number of its approaches and techniques: 72-hour follow-up calls to discharged patients, the use of discharge advocates, medication reconciliation at time of discharge, enhanced discharge planning, and BOOST’s “8Ps” patient risk stratification tool. Another popular approach in use is the “teachback” communication technique, in which patients are asked to repeat in their own words what they understand the professional has told them about their condition and self-care.
One reason many Southern California hospitals do not have a strong hospitalist presence is the widespread prevalence of independent practice associations (IPAs), which often designate members of their medical groups to fill the hospitalist role for patients at a given hospital, says Z. Joseph Wanski, MD, FA
CE, medical director of the public L.A. Care Health Plan, which co-sponsored the readmissions collaborative. Dr. Wanski, a practicing endocrinologist and a hospitalist at California Hospital Medical Center in Los Angeles, says L.A. Care will be testing the use of hospitalists at some of its contracted acute-care facilities starting in July. (Click here to listen to more of Dr. Wanski’s interview.)
At Harbor UCLA Medical Center in Torrance, a major safety-net facility for Los Angeles County, the readmissions team initially focused on heart failure patients and was able to demonstrate a 5.5% decrease in readmissions for all heart failure patients at a time when readmissions for the hospital as a whole remained the same. The team built relationships with outside partners, including a nearby adult daycare center, home health agencies, and a care-transitions coach while emphasizing early identification of patients for referral to a heart failure disease management registry. The readmissions team also was instrumental in developing the Cardiovascular Open Access Rapid Evaluation (CORE) service, an observation unit for heart failure patients aimed at allieviating ED overcrowding.
“Hospitalists have been very cooperative with our project,” reports Adriana Quintero, MSW, the full-time Project BOOST facilitator at Valley Presbyterian Hospital in Van Nuys. “They see a lot of our patients in their offices.”
Three Valley Presbyterian physicians who work part-time as hospitalists and maintain office practices have agreed to carve out time to see patients who are going home without scheduled appointments with their primary-care physicians (PCPs) within seven days of discharge.
“We find that many of our discharged patients do not call their primary-care physicians for post-discharge appointments,” says Quintero, adding that such patients often decline the hospital team’s offers for help. The readmissions team at Valley Presbyterian is redesigning its clinical multidisciplinary rounds using a rounding script focusing more on discharge planning in rounding.
Larry Beresford is a freelance writer in Oakland, Calif.