Editor’s note: The following is an excerpt from the FierceHealthPayer eBook, The Expanding Role of Pharmacy to Cut Readmissions.
Assessing which patients are at risk for readmission is not an exact science. Instead, it’s closer to handicapping a race before it’s run: Poring over a patient’s past healthcare history, present circumstances and other esoteric details to determine a risk for readmission.
But pharmacists and other clinicians don’t accomplish this by reading tote sheets. They have to perform their own form of handicapping. And for that they need data analytics. “When you’re looking at a patient population with chronic conditions, you’re not going to get 100 percent accuracy. But when it comes to a root cause, there are certain specific factors that put a patient at higher risk of readmission,” says Asif “A.J.” Ally, a pharmacist by training and vice president of clinical affairs for Argus Health Systems, a Kansas City, Missouri-based company that provides pharmacy management services to health insurers.
In general, what are the biggest predictors for readmission?
Throw out that old stockbroker television ad chestnut that “past performance is not indicative of future results.” Experts--including pharmacists--say that prior hospital admissions are a strong indicator of readmission risk.
Other data points to look for:
- Patients taking five or more medications
- Low-income patients who may not have resources to pay for their prescriptions or to access caregivers
- Elderly patients who are living alone and may not have a support system to make follow-up appointments
- Patients with specific conditions including heart failure, sepsis or congestive obstructive pulmonary disorder
- Patients who struggle with substance abuse
- Patients with low literacy and numeracy skills
South Nassau Communities Hospital, a 455-bed hospital in Oceanside, New York, uses software to analyze every patient admitted into the facility.
After the software has performed an analysis, it will score each patient at being a low, medium or high risk for readmission, says Rita Regan (pictured right), who oversees South Nassau’s performance management and care transitions program.
That gives the hospital options in terms of referring the patient to its various programs to prevent readmission, including regular post-discharge meetings with one of South Nassau’s 30 pharmacists.
Virtually every patient will suffer some sort of adverse event after hospital discharge, Ally says, whether it’s a drug side effect, a fall or some other issue. But using data to help manage patient discharges can avoid their return--and the penalties that healthcare organizations incur when that happens.
To read more about how healthcare payers and providers are using data to assess readmission risk and other ways pharmacists can improve patient care, download our free eBook, The Expanding Role of Pharmacy to Cut Readmissions.