Strategies to Reduce Costs Associated with Hospital Readmissions

Hospital administrators struggle to reduce hospital readmissions to improve hospital performance. Reducing costs of readmissions is important to hospital administrators because it may lead to an inability to meet budget requirements. Grounded by complex adaptive systems and business process quality management principles, the purpose of this qualitative single case study was to explore strategies nonprofit hospital administrators use to reduce costs associated with hospital readmissions. Participants included 4 successful hospital administrators at 1 hospital in Doha, Qatar, who have responsibility for overseeing readmissions. Data were collected using semistructured face-to-face interviews and organizational documents. Traditional text analysis was used to identify 3 themes: discharge plan and patient education, medication reconciliation, and effective follow-up appointment system. Implications for social change include patient engagement and organizational support for continuity of care at home, which prevents readmissions and its impact on treatment costs and patient’s overall wellness. Enhancing the wellness of the individuals may generate a better quality of life for residents, while hospital administrators can allocate remaining funds for community extension service

Lack of patient involvement in care decisions and not receiving written discharge instructions are associated with unplanned readmissions up to one year

This retrospective, cross-sectional study examined the relationship between aspects of inpatient communication and discharge instructions and unplanned, all-cause readmissions using individual-level data up to one-year post-discharge. Patients completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. From April 2011 to March 2014, 24,869 patients with a mean age of 52.8±19.8 years (range=18-100) were included. 18.6% of patients (n=4,821) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. In adjusted, logistic regression models, patients who felt they were not involved in care decisions were more likely to be readmitted (OR=1.34; 95%CI: 1.17-1.53), as were patients who reported not receiving written information about signs and symptoms to watch out for post-discharge (OR=1.24; 95%CI: 1.15-1.35). Odds of readmission did not differ according to understanding of medications, understanding responsibility for one’s health, or discussion of help needed when returning home. This study provides objective data, showing that specific hospital actions are associated with unplanned readmissions. It is an example of how patient-reported measures may be linked to administrative data to drive quality improvement initiatives

Missed Opportunities in Preventing Hospital Readmissions: Redesigning Post‐Discharge Checkup Policies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/1/poms12858.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/2/poms12858_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/3/poms12858-sup-0001-AppendixS1.pd

Promotion of MOST Forms Through Education About Importance of Advance Care Planning in Seriously Ill Patients

Abstract Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population. Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria for ACP discharged from the intensive care unit (ICU) and progressive care unit (PCU) of the hospital in the three months before and the three months after implementing the Educational intervention by comparing the number of MOST forms, ADs, PC, and readmissions. A Pre and Post Education survey was conducted to assess the knowledge of the providers and the nurses on ADs and PC. Results: The study identified no statistically significant differences in ADs, PC consults, and readmissions, in patients who met criteria for ACP according to the evidence-based tool pre and post Education. There was a decrease in the number of patients who died in the hospital post education. Although no MOST forms were documented, the knowledge of ADs post Education increased in the survey results and the knowledge of PC remained the same. Conclusion: An educational intervention showed a modest reduction in hospital deaths but was not effective by itself in increasing ACP discussions, PC consults, or completion of MOST forms

A tour of health care: emergency room, hospital and home

My thesis is a small tour of the health care system (emergency room, hospital and home), with special emphasis on providers. Chapter 1 analyzes how emergency room doctors change their behavior when the waiting room is crowded. The outcomes reflect the time spent with the patient, the intensity of treatment, and discharge destination. Chapter 2 extends the previous setting to inpatient care, to determine how doctors react to hospital occupancy level. It identifies doctors’ discharging criteria as a causal factor for the positive relation between occupancy rates and readmissions. The analysis in Chapters 1 and 2 contributes to the doctors’ incentives literature, explaining how these agents behave in the context of a National Health Service, with no financial incentives. Chapter 3 examines the impact of informally providing care to a partner (at home) on the physical and mental health of the carer

Optimizing Vancomycin Dosing in Chronic Kidney Disease by Deriving and Implementing a Web-Based Tool Using a Population Pharmacokinetics Analysis.

Background: Chronic kidney disease (CKD) patients requiring intravenous vancomycin bear considerable risks of adverse outcomes both from the infection and vancomycin therapy itself, necessitating especially precise dosing to avoid sub- and supratherapeutic vancomycin exposure. Methods: In this retrospective study, we performed a population pharmacokinetic analysis to construct a vancomycin dose prediction model for CKD patients who do not require renal replacement therapy. The model was externally validated on an independent cohort of patients to assess its prediction accuracy. The pharmacokinetic parameter estimates and the equations were productized into a Web application (VancApp) subsequently implemented in routine care. The association between VancApp-based dosing and time-to-target concentration attainment, 30-day mortality, and nephrotoxicity were assessed postimplementation. Results: The model constructed from an initial cohort (n = 80) revealed a population clearance and volume of distribution of 1.30 L/h and 1.23 L/kg, respectively. External model validation (n = 112) demonstrated a mean absolute prediction error of 1.25 mg/L. Following 4 months of clinical implementation of VancApp as an optional alternative to usual care [VancApp (n = 22) vs. usual care (n = 21)], patients who had received VancApp-based dosing took a shorter time to reach target concentrations (median: 66 vs. 102 h, p = 0.187) and had fewer 30-day mortalities (14% vs. 24%, p = 0.457) compared to usual care. While statistical significance was not achieved, the clinical significance of these findings appear promising. Conclusion: Clinical implementation of a population pharmacokinetic model for vancomycin in CKD can potentially improve dosing precision in CKD and could serve as a practical means to improve vital clinical outcomes

Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy

Intensive care unit recovery clinics (ICU- RCs) have been proposed as a potential mechanism to address the multifaceted unmet needs of intensive care unit (ICU) survivors and caregivers. The needs of this population include, but are not limited to, medication optimization, addressing physical function and psychological needs, coordination of care, and other interventions that may help in improving patient recovery and reducing the rate of preventable readmissions. The objective of this opinion paper is to identify and describe clinical pharmacy services for the management of ICU survivors and their caregivers in an ICU- RC. The goals are to guide the establishment and development of clinical pharmacist involvement in ICU- RCs and to highlight ICU recovery research and educational opportunities. Recommendations provided in this paper are based on the following: a review of published data on clinical pharmacist involvement in the ICU- RCs; a consensus of clinical pharmacists who provide direct patient care to ICU survivors and caregivers; and a review of published guidelines and literature focusing on the management of ICU survivors and caregivers. These recommendations define areas of clinical pharmacist involvement in ICU- RCs. Consequently, clinical pharmacists can promote education on Post Intensive Care Syndrome and Post Intensive Care Syndrome- Family; improve medication adherence; facilitate appropriate referrals to primary care providers and specialists; ensure comprehensive medication management and medication reconciliation; provide assessment of inappropriate and appropriate medications after hospitalization; address adverse drug events, medication errors, and drug interactions; promote preventive measures; and facilitate medication acquisition with the goal of improving patient outcomes and reducing health care system costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/2/jac51311.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/1/jac51311_am.pd

Care Coordination for Better Outcomes

A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated the discharge plan with the patients on admission. Discharge planning on admission and daily briefings involving care coordination and bedside staff reduced the length of stay, improved HCAPHS scores, and reduced 30-day readmissions by fostering better communication and collaboration. A 1-group pretest and posttest were utilized to compare data before care coordination and after care coordination. These findings yielded a length of stay reduction of 2.04 days, a 50% reduction in 30-day readmissions, and HCAPHS communication composite scores above the 50th percentile. The care coordination team exposed various programs and community resources that assisted with medications and durable medical equipment and suggested that companionship alleviated potential anxiety post discharge for those financially and socially burdened. The implications of a patient-centered team-based approach to discharge planning on admission eliminated barriers to discharge, improved patient knowledge of disease management, and provided a positive hospital experience