Transcript Reduction Of Hospital Readmissions

Reduction Of Hospital
Readmissions
Hany Salama, MD
Diplomat ABIM IM
Hospice and Palliative Care
Sleep Medicine
FACTS FROM NATIONAL HEALTH INTVIEW
SURVEY 2010
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38.1 Million persons were limited in their
usual activities due to one or more chronic
health conditions
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Prevalence of activity limitations due to one
or more chronic conditions increases with
age (7% under age 12, 17% age 45-64 and
43% of people age 75% or older)
• One in five discharged patients will be re-hospitalized
within 30 days
• 50% will not have interaction with a clinician prior to
readmission*
*Jencks S., et al. “ re-hospitalizations among patients in Medicare
fee for service Program” New England Journal of medicine 2009
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Geriatric population has the highest
readmission rate
The critically ill constitute 35% of
readmission in one month.
CHF and COPD exacerbations are the
leading causes of readmissions by diagnosis
Patients discharged to nursing home are less
likely to be readmitted in one month
compared to those who go home
Inappropriate Care During
Hospitalization
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Resolution of main problem
Increase temperature
IVF on discharge day
Unaddressed abnormal tests
Absence of documentation of discharge
planning
Inappropriate care During
Hospitalization
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Medication errors
Medical errors
Early Follow up with PCP
Inadequate education of caregivers
Complications Of Sending Patients
Back and Forth To Hospital from
LTC
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Increase risk of delirium
Medication errors
Falls
Infections
Death
First Conditions For Initial
Penalties
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Pneumonia
Heart Failure
Myocardial infarction
Transition Programs Post
Hospitalization
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Physician
Nurse Practitioner
Care Manager
Social worker
Nurses
Pharmacist
Nutritionist
Strategies to Reduce
Re-hospitalizations
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Service delivery reform
Financing reform
Medicare and Medicaid integrated service
and financing reform
Service Delivery Reform
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Care coordination between hospital and post
hospital settings and providers
Education patient, family, and caregivers
Patient monitoring post discharge
Some studies showed 39% lower total costs
of care
Service Delivery Reform
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Some programs begin from day of admission
Arrange follow up appointments with
physicians
Arrange follow up tests
Teach patient to identify and deal with
emergency situations
Expedite transfer of discharge summaries to
outpatient physicians
Service Delivery Reform
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Arrange post discharge services
Post discharge phone calls
Reconcile discharge plans with national
standard guidelines
Information technology availability
Create interventions that address cause of
readmission
Service Delivery Reform
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Establish Home Based Primary Care
Medical Home Models
Hospice and Palliative Care
Use home telehealth
Incentive to improve patient compliance
Financing Reforms
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Going away from fee for service model
Paying providers on good and poor behavior
Episode of care starts on day of admission
and ending when patient is not in hospital or
SNFs for 60 days
Under new payment method, the difference
between Medicare payments and provider
are retained by hospital and post acute
providers
Integrated Financing and
Delivery Models
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The Program of All Inclusive Care for the
Elderly (PACE)
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Medicare Special Needs Plans
Reason For Readmission from
Nursing Homes
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NH ill equipped to deliver the appropriate
care
LTC providers lack sufficient information
about beneficiary’s care needs
LOS in Hospital is too short
Clinical competence of nursing staff
Measures to Reduce
Re-hospitalization from LTC
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Educating CNAs about disease symptoms
Provide periodic clinical courses to nurses to
recognize signs and symptoms disease
processes
Obtaining adequate records from the Hospital
Do in house labs
Ensure drawn lab results are reported timely
Measures to Reduce
Re-hospitalization From LTC
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Consider having EKG machine
More rounding visits by the SNF providers
Nurses to round with providers to understand
patient needs more
Staff visiting patient homes to evaluate risks
of possible readmissions
Pharmacist to review any new medications
for interactions
Measures to Reduce
Re-hospitalization from LTC
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Understand disease process and aggravating
factors
Adequate nutritional support
Adequate pain control
Monitor for Depressions