Readmissions, provider communication not always linked

Poor communication between inpatient and outpatient healthcare providers doesn't necessarily cause more readmissions, according to a new study published in JAMA Internal Medicine.

The researchers looked at self-reported communication patterns by discharging healthcare providers on inpatient medical services from September 2010 to December 2011 at Johns Hopkins Hospital. Of 6,635 hospitalizations analyzed, successful direct communication occurred in 2,438 hospitalizations (36.7 percent).

Predictors of direct communication included patients cared for by hospitalists, high expected 30-day readmission rate, and insurance by Medicare and private payers. The study showed the biggest reason for indirect communication was the healthcare provider's perception that the discharge summary provided was incomplete or inadequate.

"Self-reported direct communication between inpatient and outpatient providers occurred at a low rate but was not associated with readmissions," the study concluded. "This suggests that enhancing interprovider communication at hospital discharge may not, in isolation, prevent readmissions."

Efforts to reduce readmissions are increasing as the Centers for Medicare & Medicaid Services revises readmission penalties for hospitals--a new calculation in March reduced penalties for 1,245 hospitals and increased them for 226 organizations. On Oct. 1, 2012, CMS began enforcing the hospital readmissions reduction program from the Affordable Care Act.

Last week, the Agency for Healthcare Research (AHRQ) updated its Re-engineered Discharge (RED) toolkit that includes 12 "mutually reinforcing actions" hospitals can take to reduce readmissions. The report puts special focus on overcoming language barriers and cross-cultural issues. Test results showed the RED toolkit led to 30 percent reduction in hospitalization utilization within 30 days of discharge, and a 34 percent reduction in costs per patient.

Also in March, research from Intermountain Healthcare showed hospitals that use a computerized system for discharge of heart failure patients saw 30-day readmission rates fall 2.5 percent compared with hospitals that did not use the system.

To learn more:
- read the study from JAMA Internal Medicine

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