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.