How to reduce patient readmissions
Hospital readmissions are a major focus for hospitals, as well as regulatory agencies, and hospitals have initiated programs to reduce the number of patient readmissions. Patients with chronic diseases, most commonly congestive heart failure, impact readmission rates most often.
Readmission rates publicized on Hospital Compare website
The rate of rehospitalization is now one of the core indicators measured by the Centers for Medicare and Medicaid Services. The 30-day readmission rates for the diagnoses of congestive heart failure, pneumonia and myocardial infarction are published for every hospital. You can view these on the Hospital Compare website at Hospitalcompare.hhs.gov.
Hospitals have a financial consideration to reduce these readmission rates, because reimbursements will be decreased in 2012 as part of the recently passed health care reform legislation. A 2009 study in the New England Journal of Medicine reported that the cost to Medicare was $17.4 billion in 2004 for hospital readmissions.
Statistics NEJM and JAMA
According to a 2009 issue of the New England Journal of Medicine (NEJM), studies indicate that almost 20% of Medicare patients were readmitted within 30 days, and one-third returned within 90 days. Follow-up medical care appears to play a crucial role in these statistics, as a study discussed in a May 2010 issue of the Journal of the American Medical Association (JAMA) indicates: "Patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission."
Barbara Riegel, DNSc, RN and Professor of Cardiovascular Nursing at the University of Pennsylvania School of Nursing, states that patients with heart problems are readmitted to hospitals more than any other Medicare population. "Heart failure remains the most common cardiac diagnosis in elders and one of the major reasons for hospital admission." Behavioral factors, such as a lack of compliance with discharge instructions, play a role in contributing to exacerbation of the disease, prompting patient hospital readmissions. These patients would be included in two of the three indicators—congestive heart failure and myocardial infarction—measured by CMS.
Nurses' role in reducing patient readmission rates
Mary D. Naylor, RN, Ph.D. and Professor at the University of Pennsylvania School of Nursing, states, "Nurses play a central role in the prevention of hospital readmissions. This is well-documented in a number of studies." Professor Naylor has developed an intensive readmission prevention project utilizing advanced practice nurses. Her model has advanced practice nurses following elderly high-risk patients from hospital admission through discharge and at home. Advanced practice nurses see patients in the hospital, make follow-up appointments, accompany the patients to their doctors' visits, and educate the patients to recognize and report their symptoms.
M. Brian Bixby, CRNP from the University of Pennsylvania Health Services, reports working with patients for up to 12 weeks following discharge, although in most instances, six weeks has proven to be effective. Naylor's programs reportedly save $5,000 annually per patient. Other readmission prevention projects have been initiated at various hospitals throughout the country, but Naylor's project is the most intensive. The goal of these programs is to reduce patient readmissions by focusing on establishing health goals, teaching patients to recognize and respond to their symptoms, and creating personal health records. Nurses are at the forefront of these programs to help reduce patient readmission rates in hospitals.
