Under reimbursement pressures, hospitals are examining ways to prevent readmissions, and some are identifying high-risk factors to predict which patients--particularly cardiac and colorectal surgery patients--are likely to bounce back to the hospital.
New York's Bassett Medical Center identified which risk factors linked to cardiac patients result in likely returns to the hospital: congestive heart failure, chronic lung disease, amount of time on cardiopulmonary bypass, and body-mass index over 40. Bassett Medical Center, which said its probability calculator can help predict patients' risk for rehospitalizations, also is working with Columbia University on creating a calculator using a larger database.
"If we can identify the population of cardiac surgery patients who are at high risk for readmission, we can focus our resources on this subset of patients to try to prevent readmission," said study lead investigator Dr. Kelly Bettina Currie, general surgery resident. Preventive measures include calling the patient within a day of discharge and having the at-risk patients see their primary care physician within seven days.
Likewise, Baltimore's Johns Hopkins University looked at readmissions but in colorectal surgical patients, which have notoriously high rehospitalization rates, ranging up to 40 percent, according to lead investigator Andrew M. Ibrahim, the Doris Duke Clinical Research Fellow at Johns Hopkins University School of Medicine. Researchers used three predictors of rehospitalization: high severity-of-illness, an incision site infection, and the need for a colostomy or ileostomy.
Johns Hopkins also identified ways to reduce readmissions: physicians, nurses, and social workers can coordinate care at time of discharge; patients with infections should follow up with their physicians sooner; and providers can give patients more education on nutrition and ostomy care.
Under the Patient Protection and Affordable Care Act, hospitals will be docked Medicare payments for high readmission rates starting October 2012.
For more information:
- read the press release
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