Amid growing concerns about racial and ethnic disparities in healthcare outcomes, as well as frustration over the fact that federal penalties unfairly punish providers in high-risk communities, Medicare has released a guide to help hospitals improve communication and care of minority and socioeconomically disadvantaged patients and reduce readmission rates.
Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions, such as heart failure, heart attack, and pneumonia, according to the Centers for Medicare & Medicaid Services' announcement. The agency worked with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center at the University of Chicago to help hospitals identify root causes and solutions to prevent avoidable readmissions among these populations.
The guidance includes an overview of the healthcare issues common among ethnically and racially diverse patient populations, including their increased risk of discharge without primary care follow-up; language barriers and interpreter service; lack of health literacy; and lack of community resources.
In addition to case studies that provide examples of successful interventions, the guide also includes seven strategies that hospitals can incorporate to improve readmission rates among diverse populations:
Create a robust "radar" for the most at-risk beneficiaries: Medicare advises providers to collect data on factors within the community such as race, ethnicity, language, disability and social determinants to develop a better sense of the patient population most likely to face readmission.
Identify the target: Once organizations determine the characteristics linked with readmission risk, they can implement a strategy that addresses barriers, such as health literacy, cultural obstacles or mistrust of those outside their communities. Clearly identifying and targeting such obstacles naturally leads to improvements and innovations, Medicare notes.
Assemble and deploy a multidisciplinary team: In order to address thee disparities, hospitals need to establish a care team that includes doctors, nurses, social workers and professionals farther outside the healthcare sphere such as health navigators and community health workers. The team must include members who are culturally competent, multilingual and well-acquainted with the community and patient population.
Deploy interventions that account for a community's needs and challenges: To successfully prevent readmissions, the guidance states, providers must create systems that respond to community needs, ensure patients have the social support they need and factor in the social determinants of health within the community.
Focus on systems and social determinants that put these patient populations at risk for readmissions: Hospitals need to create systems that provide patients with information that is easy to understand and culturally and linguistically appropriate. The guide encourages hospitals to use navigators and community resources to overcomes social determinants.
Make sure patients understand their diagnosis, care plans and discharge instructions: Effective communication is critical to prevent readmissions, the guide states, and providers must explain warning signs and when patients need to return for follow-up care
Develop community partnerships: Organizations must partner with the community to ensure patients continue to receive care after discharge. These partners can help address non-medical reasons for readmissions, such as behavioral and cultural barriers. "Coordinating all these efforts will separate success from failure," the report said.
Although implementing these strategies aren't easy, Leah Binder, CEO of the Leapfrog Group, told USA Today that it can be done. "Caring for patients...means knowing and understanding patients and communities with must greater depth and sensitivity than is traditional today," she said.