Reducing hospital readmissions has been a major goal in healthcare for the past decade. In 2012, the Affordable Care Act (ACA) included a provision called the Hospital Readmission Reduction Program to incentivize hospitals to reduce readmissions. A readmission or rehospitalization occurs when a patient who has been discharged from the hospital is readmitted to the hospital within a certain timeframe—usually 30 days.
Why is it important to reduce hospital readmissions?
Readmissions are costly to hospitals, patients, and payers, and reduce patient care outcomes and satisfaction. In addition, an estimated 27% of readmissions could be prevented with proper communication between healthcare providers and patients.
Drawing on health data found in electronic health records (EHRs) and health information exchanges (HIEs) can be a good starting point for understanding what patients are being readmitted and why. With that knowledge, hospitals can implement strategies that are proven to reduce the risk of readmission after a patient is discharged.
What are ways to reduce hospital readmissions?
Here are five ways to reduce readmissions that hospitals could start implementing today:
1. Use admission, discharge, transfer (ADT) data for proper transition of care
It is important for clinicians and care teams to know what is happening with their patients to provide effective interventions and outreach as they move throughout the healthcare system during or after a health-related event. Using claims or authorization data is not very effective because it takes time for that information to be processed and to reach a patient’s clinical provider. Likewise, expecting patients to call their doctor after being admitted or discharged from the hospital is not reliable. However, admission, discharge, and transfer (ADT) data can offer automated, real-time insight into what is happening with a patient.
Working with an ADT provider, hospitals can set up an ADT system as part of their hospital information system that will provide real-time notifications when a patient has an ADT event. If a patient is admitted to the hospital, discharged, or transferred from inpatient to outpatient care, it is important for their doctor and care team to know what is happening while it is happening—not days or weeks later. Setting up ADT notifications can help with reducing hospital readmissions by giving care teams the opportunity to provide timely outreach and interventions.
As an example, Brevard Health Alliance is a federally qualified health center (FQHC) in Florida that worked with Audacious Inquiry to set up Encounter Notification Service® (ENS®) with ADT data in 2018. After setting up their ADT system, Brevard was better able to track their patients and provide support, leading to a reduction in readmission rates. In its first year using ENS, Brevard saw hospital readmissions for Medicaid patients drop from 17.29% in 2017 to just 8.59% in 2018, and hospital readmission rates for Medicare patients went from 19.15% in 2017 to 13.25% in 2018.
2. Follow up with patients after discharge
Drawing on ADT data, clinicians and care teams at hospitals should have a process for follow up in place as part of the intervention and outreach method to prevent rehospitalization. Following up with patients post-discharge may seem like an obvious way to prevent readmissions, but it can be difficult to determine who in the care team should be responsible for this task, given the already heavy workload of many doctors and nurses. However, it has been proven that a simple follow up after hospital discharge can be an effective strategy to help with reducing hospital readmissions.
One study tested the value of a follow-up call within 30 days of discharge and found that patients who received a call stayed out of the hospital longer than those who did not. The city of Camden, New Jersey, implemented the 7-Day Pledge Program to connect patients with an appointment to see their primary care provider (PCP) within seven days of discharge from the hospital and found that patients who saw their PCP in the first week, post-discharge, had lower rates of readmission.
3. Identify risk factors for readmission using EHR data
Hospitals can use real-time data and predictive modeling to identify risk factors for readmission. By looking at population health data from the EHR or HIE, hospitals can evaluate common risk factors for readmission and identify patients who meet these criteria for high-risk. If the hospital utilizes ADT notifications for a high-risk patients, then they can do outreach when a high-risk patient is admitted, discharged, or transferred to proactively support care coordination.
A commonly used model for predicting readmissions is called the HOSPITAL score that comprises seven independent risk factors: “H” for hemoglobin at discharge, “O” for discharge from an oncology service, “S” for sodium level at discharge, ”P” for procedure during admission, ”I” and ”T” for index type, “A” for number of admissions in the past 12 months, and ”L” for length of stay. The HOSPITAL predictive readmissions model can be easily utilized because the data it incorporates is readily available in most EHRs and HIEs and can help hospitals to identify high-risk patients more effectively.
4. Support patient medication adherence to prevent rehospitalization
Medication adherence is an important factor when working to reduce rehospitalization. A study of hospitalizations related to medication found that 33% to 69% of those are attributed to medication nonadherence—meaning a patient stops taking their medication or fails to fill their prescription in the first place. Supporting patients with medication adherence could reduce the risk of hospital readmissions. A 2017 study found that patients with low to intermediate medication adherence had a 20% rate of readmissions compared to just 9.3% for those with high medication adherence.
Evidence of medication adherence may appear in a patient’s EHR if the patient previously had a medication-related hospitalization; other available data such as any chronic health conditions and a list of current prescriptions could also be utilized to identify patients who should receive support for medication adherence as part of a post-discharge plan.
In addition, clinical staff should work with patients to learn about their ability to access prescription medications before being discharged, to help them overcome any potential barriers to getting and taking their medications.
5. Prioritize patient understanding of discharge instructions
Another way to prevent readmissions is to ensure that patients can understand and follow discharge instructions. When it comes to patient comprehension, studies have found that most patients are not able to remember the discharge instructions they are given or are unaware that they don’t understand. This may be especially true for patients who are discharged from the emergency department (ED). A study that evaluated patients’ understanding of care instructions after being discharged from the ED found that 78% had deficient understanding in at least one of the following areas: diagnosis and cause; ED care; post-ED care; and return instructions.
The care team should make sure discharge instructions are easy to understand, that the patient knows what to expect during recovery, who to call with questions or concerns, and what are signs to return to the hospital or emergency department. Using the teach-back method to help break down information and check for understanding is one way to address health literacy. In addition to going over care instructions verbally, providing a printed sheet that covers the information for them to take home or sending a digital copy of instructions via email or a patient portal is a good practice.
Taking a patient-centered care approach can help to ensure patients adhere to care instructions after being discharged as another way to prevent readmissions.
About the Author
Diana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs.