February 13, 2012

How low can they go?

Rising health care costs and shrinking budgets have forced many health service providers, particularly hospitals, to examine ways of reducing costs by preventing readmissions. A readmission is defined as a patient admission to a hospital within 30 days of being discharged from an earlier hospital stay. There has been considerable debate surrounding the issue of whether or not readmissions are preventable. While not all readmissions are preventable, even with optimal care, there is increasing evidence showing that readmission rates are related to and reflective of hospital quality and performance.

In 2010 the Joint Commission, a national accreditation body for hospitals, released new standards emphasizing the importance of effective patient-centered communication and cultural competence on patient outcomes and readmissions. A recent study published in the January 4th issue of JAMA found that heart attack patients in the US were more likely to be readmitted to the hospital within 30 days after the heart attack than patients in 16 other countries (including Canada, Australia, and many European nations). The higher readmission levels in the US suggest that there are components of the US care system that could be modified to reduce readmissions to similar levels as those in the other countries. Some of these components include length of stay, coordination of care, and patient follow up procedures.

In August 2011, the Centers for Medicare and Medicaid Services finalized the Hospital Readmissions Reduction Program which reduces the amount hospitals are reimbursed when they have an excessive number of preventable readmissions.  While the program does not go into effect until October 1st, many hospitals across the country are being proactive about increasing the patient-centeredness of their programs to see how low they can go reducing readmissions. One example is St. Vincent’s HealthCare in Northeast Florida has been proactive about reducing readmissions by evaluating and modifying existing procedures to prioritize clear communication and coordination of patient care.

In Texas, the Literacy Coalition’s Health Literacy Forward works with health care providers to reduce preventable readmissions through health literacy interventions. One big project on the horizon is a collaborative study with Seton Healthcare Family to identify best communication practices to help reduce preventable readmissions in their hospitals. While we aren’t the first group that has wanted to look at which components of clear communication and doctor-patient interaction have the most significant effect on improving an individual’s ability to understand and act on health information, it seems like we will be doing some fairly groundbreaking research! We had a great planning meeting on Monday and I am really excited to continue developing the project over the next couple of months. Stay tuned! 

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