Survey of H2H Hospitals Shows Improvements and Inconsistencies of Readmission Reduction Strategies

While several strategies have been shown to reduce unnecessary readmissions, hospitals around the country are not consistently implementing these recommended strategies, according to a research letter published Oct. 21 in the JAMA Internal Medicine.

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The authors surveyed 437 hospitals participating in ACC's Hospital to Home (H2H) initiative between November 2010 and May 2011 and issued a follow-up survey 12 to 18 months later. Results showed several improved strategies when comparing responses from the follow-up survey to the initial survey, including: "significantly more hospitals were partnering with other local hospitals to reduce readmissions (30.7 percent vs. 22.9 percent; P= .002), were discharging patients with a follow-up appointment already made (61.1 percent vs. 52.4 percent; P= .005), and were tracking the percentage of patients who were discharged with follow-up appointments within seven days (43 percent vs. 32.2 percent; P < .001) and those readmitted to other hospitals (19 percent vs. 12 percent; P= .001)." Additionally, "more hospitals were estimating risk of admission in a formal way (34.6 percent vs. 22.5 percent; P < .001), using electronic forms for medication reconciliation (81 percent vs. 72.8 percent; P < .001), and using 'teach-back' techniques…(80.8 percent vs. 68.9 percent; P < .001)." Finally, "more hospitals were providing action plans to discharged patients with heart failure (60 percent vs. 52.2 percent; P = .005) and calling patients after discharge to follow up on postdischarge needs or provide additional education (71.4 percent vs. 62.9 percent; P < .001)."

However, the authors also discovered strategies that still have room for improvement: "less than 40 percent of hospitals had in place a process for alerting outpatient physicians about discharges within 48 hours or for following up on test results that are returned after the patient was discharged; less than one-quarter of hospitals always sent the discharge summary to the primary care physicians, and less than two-thirds always conducted nurse-to-nurse report before discharge to nursing homes."

Moving forward, the authors note that "more consistently implemented strategies to promote safe transitions from hospital to home are likely critical for reducing readmission rates in the years ahead."

Keywords: Follow-Up Studies, Nursing Homes, Outpatients, Medication Reconciliation, Physicians, Primary Care, Heart Failure, Patient Discharge, Hospitalization

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