Becker's Clinical Quality & Infection Control

65 QUALITY IMPROVEMENT & MEASUREMENT Heart failure patients admitted by geriatricians less likely to experience readmission: 7 study findings By Kelly Gooch R eadmission rates for Medicare penalty diagnoses of congestive heart failure, chronic obstructive pulmonary disease and pneumonia vary by physician, according to a study published by the Ameri- can Journal of Managed Care. For the study, researchers examined 30-day readmissions at Cambridge, Mass.-based Mount Auburn Hospital between Jan. 1, 2013, and Dec. 31, 2015. Researchers assessed for the type of attending physician, diagnosis, payer, patient demographics, discharge disposition and clinical factors such as primary diagnoses and length of stay. Additionally, researchers conducted in- terviews with both patients who experienced readmissions and patients who did not. Here are seven study findings. 1. Overall, 17,099 patients were admitted for CHF, COPD and pneumonia during the study period. All three diagnoses are considered Medicare penalty diagnoses under the ACA's Hospital Readmissions Reduction Program, meaning hospitals can be penalized if they have too many readmissions for these conditions. 2. Among those admitted for these condi- tions, 2,226 experienced a 30-day readmis- sion, which translates to a 13 percent total readmission rate. 3. e study found patients who were divorced or legally separated (15.7 percent) and widowed (15.7 percent) had a higher chance of being readmitted than married patients (11.6 percent). 4. Researchers said being Asian/Pacific Islander (7.1 percent) or "other" race (6.8 percent) and having private insurance (8.3 percent) were also linked to lower readmissions. 5. Additionally, the study found readmis- sions varied by attending type. e readmis- sion rates for CHF, COPD and pneumonia by attending type were: • Cardiologists — 18.5 percent • Intensivists — 17.4 percent • Primary care physicians — 16.7 percent • Hospitalists — 13.7 percent • Geriatricians — 11 percent 6. Interviews revealed readmitted patients were more likely than their nonreadmitted counterparts to not have an outpatient connection to a primary care provider (10.7 percent compared to 0 percent), to not be able to complete daily living activities on their own (32.1 percent compared to 11.1 percent), and to not have support of family members during their inpatient stay (17.9 com- pared to 10.7 percent). 7. e study's authors concluded: "is study found a lower readmission rate for those with CHF, COPD and pneumonia who were admitted by geriatricians, supporting the notion that enhanced care coordination lowers readmissions. Patient with lower social connectedness were more likely to be readmitted. ese findings support the value of rigorous identification of individual risk factors for readmission and of tailoring discharge planning." n Study: Physicians only right 60% of the time when treating pediatric health problems By Megan Knowles P hysicians accurately treated about 60 percent of cases for common childhood health problems, which indicates care quality may be inadequate for many of these conditions, according to a study published in JAMA. The researchers evaluated care quality for 6,689 Austra- lian children under age 16 treated for 17 common clinical conditions between 2012 and 2013. The conditions included autism, anxiety, diabetes, asthma, fever, upper respiratory tract infections and tonsillitis. The study involved 85 general practitioner clinics, 20 specialist practices and 34 hospitals in selected urban and rural locations across three Australian states. Researchers sought to understand how often care aligned with clinical practice guideline recommendations. Here are three study findings. 1. Children with mental health conditions (80 percent), diabetes (75.8 percent) and head injuries (78.3 percent) received care that was most in line with clinical practice guidelines. 2. Children with tonsillitis (43.5 percent), fever (54 per- cent) and upper respiratory tract infections (53.2 percent) received care that was least in line with these guidelines. 3. Lead study author Jeffrey Braithwaite, PhD, said several improvements could be made to the health system, including advancing EMR design to give physicians easier access to real-time information. "Australia has a world-standard healthcare system, but we could improve. Our results mirror studies in Australia and the [U.S.] sug- gesting that we need to increase provision of care in line with guidelines. This study highlights which conditions need most attention and will drive concerted efforts to improve patient care." n

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