Helping You Avoid Return
Trips to the Hospital
By Carolyn M.
Clancy, M.D.
September 4, 2012
If you or a loved
one has ever been in the hospital for a serious
condition, the last thing you want is a fast
return trip.
But that’s what
happens to 1 in 5 patients covered by Medicare,
the health insurance program for people 65 and
older,
a major study
found. Hospital readmissions within 30 days are
costly for Medicare and for patients. These
readmissions total about $17 billion each year.
Being readmitted to the hospital can also slow
down a patient’s ability to recover or cause new
problems.
The good news: We
know how to prevent many readmissions. And we
have tools to help hospitals do a better job.
Starting next
month, Medicare will prod hospitals to improve
their practices. Hospitals with high
readmissions for three conditions (heart attack,
pneumonia, and heart failure) will get paid less
than hospitals with fewer preventable
readmissions.
Why do many older
patients need to go back to the hospital so soon
after they’ve left?
Many of them are
high-risk patients. They may be frail, have
chronic conditions, or be unable to get to their
follow-up medical appointments.
Another reason is
that hospitals tend to transfer patients to less
costly settings once their condition is stable.
Getting follow-up care at a skilled nursing
facility or at home is a good option, and one
many patients prefer. But this care needs to be
carefully managed, so things like medical tests
or appointments are completed.
To meet that
goal, nearly 50 groups around the country have
begun working to improve the care for high-risk
Medicare patients leaving the hospital. The
Community-based Care Transitions Project
draws on the experience of local groups such as
the Area Agencies on Aging, the Visiting Nurses
Association, and others. This project was
created under the Affordable Care Act.
In addition,
research funded by the Agency for Healthcare
Research and Quality (AHRQ) has been used to
create tools that help hospitals reduce
readmissions.
For example, a
project at Boston University Medical Center
called Project RED found that patients who left
the hospital knowing how to deal with their
after-care needs were less likely to be
readmitted or to go to the emergency room later.
Key elements of
Project RED include --
- Educating
patients about their diagnosis while they’re
in the hospital.
- Making
appointments for needed follow-up tests.
- Making sure
patients understand how to take their
medicines.
- Calling
patients two to three days after they leave
the hospital to address any problems.
More than 260
hospitals now use parts or all of Project RED to
prevent readmissions.
A guide for
patients developed by AHRQ called
Taking Care of Myself: A Guide for When I Leave
the Hospital is based on the findings from
Project RED. It gives patients an
easy-to-understand plan for what to do when they
leave the hospital. The guide is available in
English and Spanish.
Another AHRQ-funded
program educates patients and families about
using medicines correctly when patients leave
the hospital.
Project BOOST (Better Outcomes for Older
adults through Safe Transitions) also helps
hospitals and outpatient settings work together
on patients’ care plans.
Helping patients
improve their health once they leave the
hospital is not easy or automatic. The new
effort by hospitals to prevent readmissions is a
big step in the right direction. You can help by
learning what you should do when you or your
loved ones are in the hospital.
I’m Dr. Carolyn
Clancy, and that’s my advice on how to navigate
the health care system.
Resources
Agency
for Healthcare Research and Quality
Taking Care of Myself: A Guide for When I
Leave the Hospital
http://www.ahrq.gov/qual/goinghomeguide.htm
Project RED
(Re-Engineered Discharge)
http://www.ahrq.gov/qual/projectred/
Improving
Hospital Discharge Through Medication
Reconciliation and Education
http://www.ahrq.gov/qual/pips/williams.htm
Community-based Care Transitions Program:
Centers for Medicare and Medicaid Innovation
http://www.innovations.cms.gov/initiatives/Partnership-for-Patients/CCTP/index.html?itemID=CMS1239313
Jencks SF,
Williams MV, Coleman EA. Rehospitalizations
among Patients in the Medicare Fee-for-Service
Program. N Engl J Med 2009;
360:1418-1428.
Current as of September 2012
Internet Citation:
Helping You Avoid Return Trips to the
Hospital. Navigating the Health Care
System: Advice Columns from Dr. Carolyn Clancy,
September 4, 2012. Agency for Healthcare
Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc090412.htm
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