A hospital serving a large number of patients insured by Medicare recently joined a federal quality improvement program designed to reduce readmissions of patients who have been discharged from the hospital within the past 30 days. The program provides financial bonuses if readmission rates are below an average benchmark and charges financial penalties if readmission rates are higher than average. At the end of the year, the chief medical officer realizes that the hospital will suffer significant financial losses due to excessive 30-day hospital readmissions for patients with congestive heart failure. Which of the following strategies has the greatest potential to reduce hospital readmissions for this hospital's high-risk patients?
Over half of all hospitalized patients (age >65) with Medicare insurance are readmitted within 30 days of hospital discharge. Readmissions are often used as a quality of care metric because they are often preventable and increase costs and patient morbidity. Patients with chronic conditions (eg, congestive heart failure) are at highest readmission risk, given their vulnerability to rapid deterioration (eg, fluid overload) and complex medication regimens that often necessitate frequent monitoring (eg, diuretics).
Readmissions can be reduced by interventions that improve follow-up and communication with patients, including telephone follow-up shortly after discharge (eg, first 2 weeks). Telephone outreach is frequently performed by care coordinators (health professionals who facilitate transfer of care, providing patient outreach and troubleshooting follow-up logistics). This intervention promotes:
Patient engagement, addressing patient concerns and confirming comprehension of and adherence to discharge instructions
Identification of new symptoms (eg, weight gain), enabling early management (eg, medication adjustment) before sequelae develop
Care coordination, helping ascertain and address patient obstacles to attending appointments, and preventing loss to follow-up, a major driver of readmission (over half of readmitted patients did not complete primary care follow-up)
(Choice B) Extending length of stay after patients are medically stable is not recommended due to nosocomial infection risk and poor resource stewardship (ie, efficient, evidence-based use of health care resources).
(Choice C) Reducing hospitalist workload may improve quality of in-hospital care but does not address post-discharge developments patients may experience leading to rehospitalization.
(Choice D) Sending discharge summaries to primary care physicians is recommended to promote accurate communication between providers. However, this strategy does not prevent patient loss to follow-up, a major driver of readmission. Telephone outreach engages patients directly and can address obstacles to outpatient follow-up; therefore, it has greater potential to reduce readmissions.
Educational objective:
Hospital readmissions are used as a quality metric because they are often preventable through improved patient communication and follow-up. Telephone-based outreach shortly after discharge reduces readmissions rates by preventing loss to follow-up, increasing patient engagement (proactively identifying and addressing potentially serious concerns) and care coordination (effective transition between inpatient and outpatient care).