Nurse practitioners don't improve readmissions

Although adding a nurse practitioner (NP) to a care team can improve the discharge process, it doesn't decrease patient readmissions, according to a study published in this month's Journal of Hospital Medicine.

Researchers at Boston's Massachusetts General Hospital found that using NPs resulted in more completed discharge summaries within 24 hours. NP use also resulted in more scheduled follow-up appointments and better patient attendance at those appointments.

However, despite the benefits around the discharge process, NP use didn't affect 30-day readmission rates or 30-day emergency department visits.

The study is "disappointing," study author Dr. Kathleen Finn told The Hospitalist. The research indicated that, despite the best of intentions, NP use has no significant difference on whether patients bounce back to the hospital.

The literature comes in the midst of another study published last week in the New England Journal of Medicine, in which researchers at Boston's Harvard School of Public Health found that readmissions have less to do with discharge planning than with hospital utilization. Although the researchers don't discourage improving discharges, they encourage hospitals to think about keeping patients out of the hospital altogether as a way of preventing readmissions.

The combined research may put a wrench in the transitional care process for many hospital discharge programs and may suggest that cutting readmissions means hospitals should look beyond only discharge planning.

The Journal of Hospital Medicine study, however, did find that patients were more satisfied with the discharge process because they knew who to call with questions. Other literature also indicated that patients prefer NPs over physicians; NPs earned an average score of 9.8 out of 10, compared to the average score of 7.2 out of 10 for physicians. Even though the NP use may not improve readmission rates, the benefit of utilization may reveal patient preferences for providers.

For more information:
- read the Hospitalist article
- here's the study abstract

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