Contemporary Evidence About Hospital Strategies for Reducing 30-Day Readmissions: A National Study

Study Questions:

What is the range and prevalence of practices being implemented by hospitals to reduce 30-day readmissions of patients with heart failure or acute myocardial infarction (AMI)?

Methods:

A Web-based survey was used to conduct a cross-sectional study of hospitals’ reported use of specific practices to reduce readmissions for patients with heart failure or AMI. All hospitals enrolled in the Hospital to Home (H2H) quality improvement initiative as of July 2010 were contacted. Of 594 hospitals, 537 completed the survey (response rate of 90.4%). A standard frequency analysis was used to describe the prevalence of key hospital practices in the areas of: 1) quality improvement resources and performance monitoring, 2) medication management efforts, and 3) discharge and follow-up processes.

Results:

Nearly 90% of hospitals agreed or strongly agreed that they had a written objective of reducing preventable readmission for patients with heart failure or AMI. More hospitals reported having quality improvement teams to reduce preventable readmissions for patients with heart failure (87%) than for patients with AMI (54%). Less than one-half (49.3%) of hospitals had partnered with community physicians, and only 23.5% had partnered with local hospitals to manage patients at high risk for readmissions. Inpatient and outpatient prescription records were electronically linked usually or always in 28.9% of hospitals, and the discharge summary was always sent directly to the patient’s primary medical doctor in only 25.5% of hospitals. On average, hospitals used 4.8 of 10 key practices; <3% of hospitals utilized all 10 practices.

Conclusions:

Although most hospitals have a written objective of reducing preventable readmissions of patients with heart failure or AMI, the implementation of recommended practices varied widely. More evidence establishing the effectiveness of various practices is needed.

Perspective:

The importance of preventing readmissions to patients, hospitals, and the national health care cost is ever increasing. Nearly one in four patients hospitalized with heart failure and one in five patients hospitalized with AMI are readmitted within 30 days of discharge. That only 25% of hospitals send the discharge summary directly to the primary care physician reflects how poorly the US health care post-discharge system is working. Among the benefits of a national electronic medical record system will be the ease of communication of the hospital course, recommendations, and treatment to primary care physicians who are responsible for much of the continuity of care.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, Acute Heart Failure, Hypertension

Keywords: Myocardial Infarction, Follow-Up Studies, Cross-Sectional Studies, Health Care Costs, Inpatients, Electronic Health Records, Prevalence, Outpatients, Cardiac Pacing, Artificial, Patient Readmission, Heart Failure, Cardiovascular Diseases, Hypertension


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