Critical analysis of The Influence of a Post discharge Intervention on Reducing Hospital Readmissions in a Medicare Population by Costantino, M. E., Frey, B., Hall, B. & Painter, P. October 2013 16(5), 310-316.
Interventions Reducing Readmissions
Abstract
Discharging patients from a hospital is a complex and intricate process that should be handled with a lot of attention and care to avoid the unnecessary readmission of patients. The study states that some reasons cause hospital readmission in Medicare patients between 30 days of discharge and they may include failure to follow the physician’s directions, reoccurrence of the condition, lack of follow-up care and not being able to understand the physicians’ guidelines. The authors examined how telephonic interventions on patients who had been discharged have reduced readmission cases within 30 days. The study also highlights that with the increased number of Medicare enrollment, there is a projected rise in the costs of utilizations among this particular group of patients. The study indicates that the telephonic intervention was monitored and the number of readmitted patients within 30 days of discharge was recorded against those that were not readmitted and it was determined that the number of patients who received telephonic intervention was significantly lower. This study seeks to explore the available interventions in Medicare apart from telephonic intervention and how they can considerably reduce the number of readmission cases. The study will also attempt to address how these particular interventions can reduce readmissions within 30 days of discharge as well as underlying causes of readmissions especially after spinal surgery among patients.
Critical analysis of The Influence of a Post discharge Intervention on Reducing Hospital Readmissions in a Medicare Population by Costantino, M. E., Frey, B., Hall, B. & Painter, P. October 2013 16(5), 310-316.
Of all the 35 million discharges that occur every year, it is estimated that 20% are readmitted after within 30 days of discharge (Jencks, Williams & Coleman 2009). A lot of emphases should be put in the intervention that reduces the number of readmission within the 30 days of discharge. The cost of readmission will be significantly reduced as well as improving the quality of life for patients and, therefore, policymakers in the health sector need to come up with ways of ensuring that the interventions that are available can significantly reduce the number of readmissions. Healthcare providers also need to explore new research on the best interventions to offer to ensure reduced cost that come as a result of readmission and improve the quality of life of a patient to avoid readmission within 30 days of discharge. The 30-day rate of readmission is today widely used as a quality metric for performance for both medical institutions and their practitioners. Analyzing the rate of these readmissions helps in developing strategies and policies that will ensure reduction of the occurrence of these readmissions.
When the interventions were made, there was close monitoring and observation of the rate of readmission and the timing of the response, and it was determined that there was a greater reduction of readmission cases when intervention was made closest to the date of discharge. However, there were an increased number of physician office visits which on the other hand indicates that most patients preferred to seek assistance and guidance and this led to avoidance of readmission. Therefore, the study suggests that intervention or support that is offered to patients after discharge from the hospital significantly reduces the number of cases off readmission within 30 days.
Data shows that the number of people enrolling for Medicare continues to increase each year which leads to needing to evaluate and assess as well as looking for ways and strategies to control the rising cost of healthcare. Reducing the number of cases of readmission due to preventable complications is one way of reducing the cost of healthcare and also ensuring that the quality of life of the patients is reduced considerably. Making follow-ups on discharged patients through telephones and determining how their recovery process is going greatly encourages them to adhere to the instructions and guidelines given to them by physicians. Other forms of interventions that can also reduce hospital readmission include patient education, patients’ needs assessment, making a timely appointment for outpatient patients and making appropriate medical reconciliation. Patients who are suffering from severe conditions like spinal injuries, heart or cardiac complications and other chronic diseases often need to require constant interventions to ensure that they make steady recovery after being discharged without the chances of getting readmitted.
Summary
The effects of different interventions like telephone follow-ups on the rates or number of readmission cases are related to the number of components that are implemented. Reduction in the readmission cases is unlikely to be reduced by single-component interventions. Enhanced communication, improved care planning, training on management of common medical conditions such as spinal injuries and improved medical safety also significantly reduce readmission cases. Spinal surgeries have become possible due to advanced instrumentations and improved technologies to ensure fewer cases of readmission. Although there is little data about what causes early readmission after spinal surgeries, it is used to evaluate the quality of care that is being offered to the patient (McCormack, Hunter, Ramos, Michels, Hutzler & Bosco 2012). Early readmission in spinal surgeries may also be used to assess the performance of a medical facility and the practitioners and the quality of attention that they provide for their patients.
Many institutions consider some readmission avoidable, and they may reflect the inadequate transitional care and poor quality of care before or during discharge. The need for bed space and postoperative bed use has also contributed to systematic discharges which have been linked to a high rate of readmissions within 30 days. Lack of help for those transitioning to home care from hospital care and lack of follow-up care can also lead to high cases of readmission because patients who have undergone critical spinal surgeries need close monitoring to determine the recovery process which in turn may decrease readmission instances. Some interventions of ensuring a lower readmission rate include the program that fines hospitals up to 1% in the first year for high cases of patients who have been diagnosed with critical conditions such as congestive heart failures, pneumonia, and spinal problems. If improvements are not made or implemented by the third year, then the fines will increase up to 2% so that the hospitals can work on their performance and quality of care that they provide (Costantino et al. 2013).
Analysis
One of the intervention methods of ensuring that there are a reduced number of readmission cases is to make a frequent follow-up of the recently discharged patients by way of telephonic support because many studies have indicated that it helps lower the incidences of readmission. Consequently, many programs have examined the viability of this method and it has been determined that it substantially impacts lowering the cases of readmission. The success of this intervention approach has been instrumental in setting a precedent in other studies that may determine the best efforts or methods to employ to decrease these cases. Hospitals should also offer help to caregivers on how best they can handle the patients after discharge so that they can provide quality care which will make the recovery process faster hence reduces the chances of readmission. Such programs that offer support to caregivers, patients, and families of patients on the best intervention will be very influential and helpful in discharging quality care to reduce readmission.
The study indicates that telephone contact between the hospital and the discharged patients was established so that cases of preventable readmissions can be avoided. The patients who are the highest risk of readmission were more closely monitored, and health professionals like nurses and clinicians often made contact with them, their caregivers or their families to watch their post-discharge recovery process. The patients were also notified of the signs and symptoms to be aware of and were also given instructions about their follow-up appointments with their physicians. To ensure minimum readmission cases, the instructions that were given would continually be determined if they were implemented and if the patients received all the medical help or equipment that they needed.
The telephonic contact between the hospital and the discharged patient is also meant to follow up if there were any prescriptions given to the patient and if they were filled in correctly. Failure to follow prescription orders sometimes can be a cause of readmission within 30 days. It also gives the patients or their caregivers a chance to inquire or ask any health-related question from their physician and get help and assistance on how to perform various daily activities. In some cases like spinal surgery, there is some medical equipment that is required to aid the recovery process of the patient and to make regular follow ups and interventions can determine if the equipment is being used well and if their routine has been implemented. More emphasis has now been put on transition care more than ever before to ensure that patients receive the best care with the assistance of the hospital to reduce readmission. Poor intervention methods may lead to readmission, but the facilities need to ensure that when they are releasing or discharging the patients, they will receive the best care there is to improve their recovery and avoid or prevent being readmitted again. Caregivers and families should be able to understand instructions given during discharge so that they can implement the requirements like administering proper meals promptly, reminding patients of their follow-up visits or appointments and checking that adequate support is in place.
Conclusion
It is no doubt that readmissions can be risky for patients, costly, and preventable. Many cases have been attributed to poor transition care and lack of proper post-discharge instruction and poor quality of care after discharge. Many strategies and approaches have been formulated to address this issue by determining what kind of support or intervention can be appropriate in improving the health of the patients. Similarly, coming up with policies that will help support caregivers while giving help to the patients should be given equal attention in ensuring that preventable readmission cases within 30 days of discharge are avoided. The study concludes by outlining that post-discharge interventions like telephonic contact have significantly reduced the number of readmission cases. There should also be the shortest time frame possible between when the patient is discharged and when the intervention is administered to ensure timely administration and implementation of the program. All the response cases that were evaluated indicate that post-discharge intervention reduced the likelihood of readmission within 30 days of discharge and that there should be awareness to sensitize members to be aware of the steps to take and the approaches to observe to reduce the chances of readmission. When readmission cases are fewer, there is an overall reduction in costs that are incurred by both the patients and the hospitals which will give financial benefits to both parties.
Reference
Jencks, S. F., Williams, M. V. & Coleman, E. A. (2009). Rehospitalizations among Patients in the Medicare Fee-for-service Program. New England Journal for Medicine, 360, 1418- 1428.
McCormack, R. A., Hunter, T., Ramos, N., Michels, R., Hutzler, L. & Bosco, A. (2012). An Analysis of Causes of Readmission after Spine Surgery. Spine, 37(14), 1260-1266.
Costantino, M. E., Frey, B., Hall, B. & Painter, P. (2013). The Influence of a Post discharge Intervention on Reducing Hospital Readmissions in a Medicare Population. Population Health Management, 16(5), 310-316.
