Becker's Clinical Quality & Infection Control

8 REDUCING READMISSIONS Readmissions Past 7 Days May Be Out of Hospitals' Control, Study Finds By Brian Zimmerman M ost hospital readmissions beyond seven days are attributable to factors beyond a hospital's control, findings from a study published in Health Affairs suggest. For the study, researchers examined hospital discharge records for nearly 7 million Medi- care patients treated at 910 hospitals located across Arizona, California, Florida and New York. Researchers focused their analysis on three conditions: acute myocardial infarc- tion, heart failure and pneumonia. Robust statistical analysis revealed limit- ed variation between hospitals regarding 30-day readmissions across all conditions with variations ranging from 0.8 percent for surgery to 1.1 percent for pneumonia. e analysis also displayed higher variations (3.2 percent readmission variation for pneu- monia patients on the first day following discharge) between hospitals within the first week post-discharge, indicating that this may be a more accurate measure of readmis- sions associated with hospital care. Researchers also found that many readmis- sions at 30 days and beyond could oen be linked with factors attributable to the com- munities the hospitals served. CMS's current risk-standardized readmission models adjust for patient age, sex and clinical characteris- tics, but not for community influences. "If the goal of current public policy is to encourage hospitals to assume responsibility for post-discharge adherence and primary care follow-up, then penalties assessed for readmissions within 30 days or longer peri- ods might align appropriately. However, if the goal is empowering patients and families to make healthcare choices informed by true differences in hospital performance, then a readmission interval of seven days or fewer might be more accurate and equitable," concluded the study's authors. n Community Health Workers Can Help Reduce Hospital Readmissions By Heather Punke B ringing in community health workers to help chronically ill patients access care after a hospitalization can dramatically re- duce readmission rates, according to new data from Towson-based University of Maryland St. Joseph Medical Center and Maxim Healthcare Services, a provider of home health, staffing and population health services. UMSJMC's program partners community health workers with patients at high risk for readmis- sion due to medical, psychological, functional and socioeconomic complexity. The community health workers focus on several issues with the patients, including transportation, housing and employment. The program reduced readmissions among participants by more than 60 percent in its first 16 months. "Readmissions aren't the problem — they are the symptom. The real problem occurs when pa- tients with complex medical issues and unman- aged psychological or social challenges don't receive the support they need to maintain their health," aid Mohan Suntha, MD, former UMSJMC president and CEO and current president and CEO of the University of Maryland Medical Cen- ter in Boston. n Safety-Net Hospitals See Decline in Readmissions Despite Policy Challenges By Brian Zimmerman F rom 2013 to 2016, combined 30-day readmissions for heart attack, heart failure and pneumonia patients saw sharper de- clines in safety-net hospitals than other hospitals, according to a study published in Health Affairs. The authors of the study used data from Medicare's Hospital Com- pare website to analyze readmission rates for safety-net hospitals and other hospitals for the fiscal years 2013 and 2016. Research- ers found overall readmissions rates declined more at safety-net hospitals than other hospitals. Heart attack readmissions saw a 2.64 percent decline at other hospitals and a 2.86 percent de- crease at safety-net hospitals, causing the study's authors to note that there was more room for improvement among the safety-net hospitals. In 2013, the ACA's Hospital Readmissions Reduction Program granted CMS the ability to penalize hospitals for 30-day readmis- sions exceeding national readmission averages. The move drew criticism from safety-net supporters because these facilities care for the nation's most vulnerable populations, which are more likely to be readmitted 30-days after hospitalization. "In refining the HRRP, policy-makers should bear in mind that a penalty program may not provide the best lever for incentivizing performance improvement in safety-net hospitals," concluded the authors. "It would be advisable for CMS to pay attention to charac- teristics of hospitals that succeed in reducing readmissions as it modifies and expands the HRRP." n

• Cover