To reduce readmissions, focus on patient, not condition

Efforts to reduce hospital readmissions should address individual patients rather than their conditions, according to healthcare providers, Becker's Hospital Review reports.

This means providers must think about patients after discharge and ensure they fully understand discharge and prescription instructions. 

"We actually have patients who went home with generic medication…at home they had the brand name, and took both. They were double-dosing themselves," Kathy Donofrio, associate vice president of nursing and director of cardiology at Swedish Covenant Hospital in Chicago told Becker's. "Then they're back in the ER because their blood pressure is low because they took the same medication twice."

Faced with a 30-day Medicare readmission rate above the national average of 16 percent, Swedish implemented a care transition program in an effort to reduce readmissions. As part of that initiative, the hospital sends wellness coaches to patient homes to clarify confusing medication instructions. During the first 10 months of last year, Swedish's readmission rate dropped below the national average to 14.25 percent, according to Becker's.

Children's hospitals in the Philadelphia area like Children's Hospital of Philadelphia (CHOP) and St. Christopher's Hospital for Children have implemented similar home-visit interventions to prevent emergency room visits. However, a medication adherence-centered targeted intervention improved adherence among high-risk heart failure patients, but did not significantly affect readmissions, FierceHealthcare previously reported.

In addition to improving patient outcomes, Swedish also implemented the new care transition program as part of incentives offered through the Medicare Hospital Readmissions Reduction Program, which began in fiscal year 2013. Two-thirds of U.S. hospitals were penalized under the agency's program last year, with 18 hospitals receiving the maximum penalty for excessive readmissions. Providers have raised concerns that these penalties will hit safety-net hospitals like Swedish hardest, and a research letter last January backed this up, projecting that 44 percent of safety-net hospitals will be affected by the penalties, compared to only 30 percent of other hospitals.

To learn more:
- read the Becker's article