Becker's Clinical Quality & Infection Control

10 REDUCING READMISSIONS Addressing 30-Day Readmissions of PCI Patients May Not Improve Mortality Rates By Brian Zimmerman W hile 30-day readmission rates for percutaneous coronary interven- tions have been considered as a potential quality measure, there is a lack of correlation between 30-day PCI readmis- sion and mortality risk at the hospital level, according to a study published in the Journal of the American Heart Association. PCIs are non-surgical procedures that use a catheter to implant a stent, which makes room for blood vessels that have been constricted by plaque buildup. e rates of 30-day readmissions among this patient group are relatively high and associated with an increased likelihood of death within the first year. But at the hospital level, the relationship between PCI readmissions and mortality is less clear. For the study, researchers examined data on more than 41,000 PCI patients from e VA Clinical Assessment, Reporting and Track- ing Program collected from October 2007 to August 2012. Overall, 12.2 percent of patients needed to be readmitted within 30 days of their procedure, although that rate ranged from 6.6 percent to 19.4 percent depending on the center. Readmitted patients displayed an increased risk of mortality within one year aer adjusting for potential contributing fac- tors. However, when the readmission rates and mortality rates were adjusted at the hos- pital level, no significant correlation between the two numbers could be established. "Strategies to reduce readmissions aer PCI and to improve outcomes in this high‐risk patient population are greatly needed. With a nearly 50 percent increase in risk of mortality aer controlling for the patient‐ risk factors, patients readmitted aer PCI require careful consideration to discover the impact of nontraditional risk factors," wrote the authors. "It is unlikely that incentivizing hospitals to avoid post‐PCI readmissions will impact the increased mortality of this high‐risk group ... Efforts directed at reducing readmissions may improve patient satisfaction and cost while separate efforts directed at understanding the underly- ing association between readmission and mortality may someday lead to improved survival in this high‐risk group." e authors acknowledged their findings were limited since the patient population of their study was 98 percent male. n To Lower Readmissions, Invest in These 6 Occupational Therapy Interventions By Brian Zimmerman I ncreased investment in occupational therapy was the only category identified by researchers where addi- tional hospital spending displayed a strong association with a reduction in readmission rates, according to a study published in Medical Care Research and Review. For the study, researchers conducted an analysis of Medi- care claims and cost data to establish links between 19 specific spending categories and 30-day readmissions for heart failure, pneumonia and acute myocardial infarction. The analysis included 2,791 hospitals for readmissions re- lated to heart failure, 2,818 hospitals for pneumonia and 1,595 hospitals for acute myocardial infarction. According to the study's authors, the analysis revealed "occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three med- ical conditions." Frederick P. Somers, CEO of American Occupational Therapy Association, said, "The findings of this important study highlight just one of the many roles occupational therapy practitioners are playing in improving quality and reducing healthcare costs." Researchers identified six occupational therapy interven- tions that could lower readmissions. 1. Provide the patient's caregivers with recommendations and training, better equipping them to help the patient return to daily functionality. 2. Thoroughly evaluate patients regarding their capabilities to live safely and independently and deter- mine whether they require additional rehabilitation or nursing care. 3. Make assistive devices available to patients with exist- ing disabilities, enabling them to safely perform essential daily activities. 4. Determine the safety of a patient's home prior to discharge and suggest modifications to improve safety. 5. Assess a patient's cognitive capabilities and whether he or she is physically dexterous enough to manipulate medication containers — provide training as necessary. 6. Collaborate with physical therapists to intensify inpatient rehabilitation. n

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