1. Addressing the Problem of Hospital Readmissions Arya Sedehi HS 8803

2. 2 Statistics Hospitals account for 31% of total health expenditures Medicare Beneficiaries –19.6% of patients are readmitted within 30 days –Accounts for $15 billion in spending

3. 3 Types of Readmissions Hospital Readmission AvoidableUnavoidable Clinical Characteristics DemographicOperational Factors PlannedUnplanned

4. 4 Types of Readmissions (1) Avoidable –Result of medical error, lack of social support or lack of understanding of discharge instructions –Shows poor quality of care Unavoidable –Necessary based on diagnosis of patient

5. 5 Avoidable Readmissions Demographics Clinical Characteristics Operational Factors

6. 6 Avoidable Readmissions (1) Demographics

7. 7 Avoidable Readmissions (2) Clinical Factors Medications Comorbidities

8. 8 Avoidable Readmissions (3) Operational Factors

9. 9 Hong Kong Case Study Causes of Readmissions

10. 10 Current Proposed Solutions During Hospitalization

11. 11 Current Proposed Solutions (1) At Discharge

12. 12 Current Proposed Solutions (2) Post-Discharge

13. 13 Current Proposed Solutions (3) Project BOOST Preliminary Results –Improved St. Mary’s readmission –Improved patient satisfaction

14. 14 Priority-Based Strategies Low Effort Strategies –Implemented with hospital’s existing resources Medium Effort Strategies –May require hospitals to acquire additional resources High Effort Strategies –May necessitate installation of complex and costly systems

15. 15 Priority-Based Strategies (1) Case Study –Multisite randomized controlled study –Coordination of care across multi-disciplinary team –Use of EMRs to support care coordination –Use of Transitional Care Nurse to coordinate care –High Effort –Annual average savings at $4,845 per patient

16. 16 My Considerations Focus on pre-discharge, at-discharge, and post- discharge interactions with patient and caregiver Make sure patients adhere to Medicine Reconciliation Utilize IT to track readmissions over time and create an index Change hospital reimbursement depending on readmission rates

17. 17 My Considerations (1) RFID Technology

18. 18 My Considerations (2) Patient and Asset Tracking

19. 19 My Considerations (3) Benefits of RFID tracking in hospitals –Improves equipment utilization & reduces losses –Improves staff productivity and efficiency –Can reduce medical errors and improve patient care

20. 20 Questions? References Allaudeen, Nazima. 2011. “Redefining readmissions risk factors for general medicine patients,” Journal of Hospital Medicine. 6, 54-60. Benbassat, J. and M. Taragin. 2000. “Hospital readmissions as a measure of quality of health care,” Archives of Internal Medicine. 160(8), 1074-1081. California Health Advocates. 2010. “Creative interventions reduce hospital readmissions for Medicare beneficiaries.” http://www.cahealthadvocates.org/news/basics/2010/creative.html Catlin, A. et al. 2008. “National health spending in 2006: A rear of change for prescription drugs,” Health Affairs, 2714-2729. Halfon, Patricia. 2002. “Measuring potentially avoidable hospital readmissions,” Journal of Clinical Epidermiology, 55, 573-587. Health Research & Educational Trust. 2010. “Health care leader action guide to reduce avoidable readmissions,” Minott, Jenny. “Reducing hospital readmissions.” Academy Health. http://www.academyhealth.org Personal Communication with Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H., April 2008. SMM Project BOOST. “Reducing unnecessary readmissions and so much more.” Society of Hospital Medicine. Westert, Gert. 2002. “An international study of hospital readmissions and related utilization in Europe and the USA.” Health Policy, 61, 269-278.