Transcript Slide 1

7A Improving Patient Outcomes by Decreasing Patient Readmission
Rates
Authors: (Marlena Didonoato) Karen Eggers, 7A staff , Dr Rhode, Donna Mcclish, Deby Evans, Winnie Wood, Medicine
Hospitalist Service, Gail Sinwell, and the Transition of Care Project Team.
University of Michigan Hospital and Health Centers, Ann Arbor, Michigan
Implementation Strategies
Purpose
The goal of Transitions of Care is to prevent or
decrease avoidable patient readmissions to the
hospital within 30 days of discharge and to improve
transfer of information to discharge providers
 Interventions are put in place to mitigate the risks for readmission as much as
possible.
 Interventions include using the teach-back process during patient education (having the
patient repeat information and education in their own words).
 Early referrals based on the patients responses to questions asked upon admission.
 Answering “yes” to unexplained weight loss, non healing wounds, would trigger a nutrition referral.
 Answering “yes” to having financial concerns or having been admitted within the last 30 days would trigger a
social work or discharge planner referral.
 Unit Champions provided staff education regarding:
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Synthesis
The Medicare Payment Advisory Commission (MedPAC)
reported “18% of Medicare hospital admissions result in
readmissions within 30 days of discharge, accounting for $15
billion in spending.” Centers for Medicare and Medicaid
Services have proposed to adjust reimbursement rates to
institutions in relation to avoidable hospital readmission rates.
The University of Michigan Health System is involved with
other initiatives and institutions across Michigan to reduce
hospital readmissions.
Change
In July 2010, unit champions utilized the “Better Outcomes
for Older Adults through Safe Transitions” (BOOST) Risk
Assessment tool to create an admission check list. RN’s
utilize the admission check list to identify Predictors for
readmission include problem/high risk medications,
depression, polypharmacy, a new diagnosis, poor health
literacy, lack of patient support, and prior hospitalization
within the last 6 months.
Impact of avoidable readmissions
Importance of decreasing/preventing readmissions
All aspects of the risk assessment form (risks and interventions)
When and how to place relevant referrals
Teach-back process
Significance
• The hospital readmission rate for 2009 was 15.44%.
• In July 2010 the pilot on 7A was implemented and for 2010 the
readmission rate decreased to 15.39%.
• The TOC program has now been implemented on two other units
within the hospital (5B and 4A) and as of February 2011 the mean
readmission rate was 14.14%.
 Staff viewed teach back videos
 Staff observed and evaluated each other performing teach-back
Evaluation
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The unit receives reports daily with information about patients that have been readmitted within 30 days
of discharge from Clinical Information & Decision Support Services (CIDSS).
• Reports contain the patients readmission diagnosis, admitting service, previous admission
diagnosis and service, number of days since discharge, and discharge disposition.
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The readmission diagnoses varied. Patient that were readmitted with the same diagnosis were
due to exacerbations but >85% were due to an unrelated diagnosis
According to current data from CIDSS, readmission rate were 23.21% in July 2010 and 14.56% as in April 2011 (number of
monthly discharges ranged from 168 to 142).
University of Michigan Health System
30Day Readmission Unit 7A1
July 2010 through April2011
25.00%
20.00%
15.00%
References
Institute for Health Improvements Reducing Readmissions by Improving Transitions of Care
http://www.ihi.org/IHI/Programs/Collaboratives/IHICollaborativeIReducingReadmissionsbyI
mprovingTransitionsinCare.htm
Institute for Health Improvements: State Action on Avoidable Rehospitalizations Initiative
http://www.ihi.org/IHI/Programs/StrategicInitiatives/StateActiononAvoidableRehospitalizat
ionsSTAAR.htm
10.00%
5.00%
0.00%
MedPac:Reforming Americas Healthcare Delivery System, April 21, 2009 (p5)
http://www.medpac.gov/documents/Hackbarth%20Statement%20SFC%20Roundtable%2
04%2021%20FINAL%20with%20header%20and%20footer.pdf