Decreasing Readmission Rates: 2 Interventions That Worked

1Maryland General Hospital, Baltimore, MD

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 188

Background:

About 18%–20% of Medicare beneficiaries who are discharged from a hospital are readmitted within 30 days. The health care spending related to this has been estimated at $17 billion. Furthermore, Congress and President Obama as a resource for reducing Medicare spending have incorporated in the health care reform a section that will enable the Secretary of Health and Human Resources to oversee this issue directly and to penalize providers financially who are off the criteria determined by the secretary.

Purpose:

To find interventions that will decrease 30‐day readmission rates

Description:

We developed 2 new interventions in our discharge planning. (1) We incorporated a 48‐hour follow‐up process. (2) We perform the follow‐up appointment at a clinic belonging to the hospital and not with the patients’ primary care doctor (PCP). Our study included patients from a major HMO in the state. An instrument to record the interventions was created and implemented. The follow‐up process started by identifying by 10 AM all possible discharges for the day. Between 10 AM and 11 AM, the decisions to discharge were made. Between 11 AM and noon, the hospitalist performed the following activities: (1) contacted the clinic directly and set up the appointment, (2) populated the follow‐up instrument with the day and time for the appointment, (3) met with the patient and family members to counsel about the importance of the follow‐up, and (4) provided the patient and family with all the appropriate discharge instructions. The hospitalist office called the patient 24 hours before the appointment and followed up all patient appointments and no‐shows. No‐shows were called the same day they missed the appointment to identify reasons and to provide and opportunity for rescheduling within 24 hours. Before this program, the readmission rate for all causes and for the same kind of patient population for the HMO in the past 6 month was 26%. During the first 2 months of the intervention, 52 patient from this HMO were discharged from the hospital. A 48‐hour follow‐up appointment was done for 100% of them. Among the discharged patients, 16 (30%) went to the 48‐hour follow‐up. The readmission rate after 30 days of discharge for these 16 patients was 1% (1) versus 16% (6) in the group that did not go to the 48‐hour follow‐up.

Conclusions:

Our new interventions reduce readmission rates in this population. It demonstrated that having a close follow‐up helps decrease patient readmission. In this study we also demonstrate that having an initial follow‐up at the same place were the patient was treated could be a better first option than doing the initial follow‐up at the regular PCP office.

Disclosures:

D. F. Martinez‐Vasquez ‐ none

To cite this abstract:

Martinez‐Vasquez D. Decreasing Readmission Rates: 2 Interventions That Worked. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 188. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/decreasing-readmission-rates-2-interventions-that-worked/. Accessed March 28, 2020.

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