Care coordination key to low readmission rates by geriatricians

Three nurses walking down a hospital corridor
Geriatricians have the lowest 30-day readmission rates for conditions that carry value-based penalties under the Hospital Readmissions Reduction Program. (Image: Getty/VILevi)

New research provides further evidence that enhanced care coordination can make a difference in lowering hospital readmission rates.

The study, published in the American Journal of Accountable Care, considered the types of admitting physicians and found geriatricians have the lowest 30-day readmission rates for conditions that carry value-based penalties under the Hospital Readmissions Reduction Program.

The researchers looked at rates of readmission from 2013 to 2015 at Mount Auburn Hospital in Cambridge, Massachusetts, a Pioneer accountable care organization.

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RELATED: Study links financial penalties to lower readmission rates

They found a lower readmission rate among geriatricians for patients with congestive heart failure, chronic obstructive pulmonary disease and pneumonia. Researchers attributed that to the care model used by those geriatricians, as those doctors provided continuity of care to their own patients across the inpatient and outpatient settings.

In addition, they developed a highly coordinated care model that includes the use of post-discharge home visits, enhanced palliative care and attention to care goals supervised by a multidisciplinary team of providers who know the patient.

“Adoption of similar models by other attending types for high-risk patients may be an effective strategy for lowering readmission rates,” the study authors said.  

The research supports the idea that enhanced care coordination lowers readmissions, the researchers said. They also found that patients who didn't have social connections were more likely to be readmitted, demonstrating that hospitals should pay more attention to the context of patients’ lives as they develop discharge plans to identify those at high risk of readmission and provide enhanced services to meet their needs.

RELATED: Federal Hospital Readmission Reduction Program linked to higher death rates in UCLA study

The Centers for Medicare & Medicaid Services penalized half of U.S. hospitals for readmission rates in 2016.  The penalties are controversial, and major professional organizations such as the American Hospital Association, have questioned the methods used to assess the data.

One study last year also found the federal push to reduce readmission rates may be leading to higher related death rates. Researchers examined data on more than 115,000 Medicare fee-for-service beneficiaries at 416 hospitals and found that while the program was indeed linked to reduced readmission rates for patients with heart failure, it was also linked to higher death rates for these patients. 

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