Today’s Archives of Internal Medicine has two interesting and instructive studies on readmission prevention.
The first examines the use of health coaches in a real world intervention. The findings, while encouraging at first glance–the coaches decreased readmission rates, also convey another message. Look at the percent of those participants who declined to participate (~50%), and those who completed the trial and accepted coaching (~25%):
This expresses two points: 1) Recruitmet and retention of subjects is difficult, and 2) Can a hospital be held harmless if an intervention is offered, the patient refuses, AND the patient returns to the ER shortly after going home? Hmmm. Ironically, patients who had greater numbers of past admissions were likelier to turn down the service.
The second trial uses advanced practice nurses to render home-based care in a cohort of CHF patients. The intervention succeeded in reducing readmissions, but not surprisingly, was a net financial loss for participating institutions.
The investigators, in addition to displaying the base case outlay below, also determine direct costs in “P4P” and bundled payment scenarios. From the table, hospitals will not likely jump at the opportunity to reduce readmits, at least by 2011 standards.
The studies are more nuanced than described above and require a read to glean all the facts, but they add to the (incomplete and maturing) science in this domain.
UPDATE: A CMAJ release: Avoidable readmissions…or not.
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.