Proven care transition models are out there
Proven care transition models are out there
A recent study in the New England Journal of Medicine, "Rehospitalizations among patients in the Medicare fee-for-service program," is getting a lot of press and attention, and was the subject of a webinar presented by The Commonwealth Fund. That organization's vice president, quality improvement and efficiency, Anne-Marie Audet tells Hospital Peer Review why readmission rates should be one of your top priorities.
Rehospitalization rates, she says, are "not a new problem... It's not good for patients, it's potentially harmful, it's very costly. It's prevalent in every corner of our country; in every state there's problems with readmission. So it's one area that we could put a national priority on. And I think from President Obama and his health care team reducing hospitalization is certainly a priority in terms of improving the quality and efficiency of our health care system."
Making it a nationwide priority, she says, is the way to go. "We do have areas in the past like diabetes and obesity, where there seems to be an agreement and a lot of effort being done nationwide and you can see the impact. So rehospitalization has that potential of improving care, reducing cost, and addressing effectiveness, safety, care coordination, being patient-centered, and reducing the waste."
And she says, reducing readmission rates is an area where there is a lot of "solid evidence" on how to improve. She points to three transition models also mentioned in the New England Journal of Medicine study. "There's Brian Jack with reengineering discharge (Project RED). That's been evaluated, shown to reduce cost, and reduce hospitalization. You have Eric Coleman's care transition program. Mary Naylor also has a transition program that's she tested for health plans."
While the Centers for Medicare & Medicaid Services (CMS) looks at ways to incentivize reducing rehospitalizations, Audet says how we currently pay for care "really doesn't provide the right signal. We pay for services one by one. So basically the signal for providers is, 'Let's do services.'"
She says the study's finding that 50% of patients who come back to the hospital never saw a provider points to "the fact that we have a gap in coordination when the patient leaves the hospital."
"And that's where some of the transitional care models come in" — to manage the transition period from when the patient is no longer in the hospital but is not seeing his or her primary care physician. Some hospitals, she says, attempt to manage that period by visiting the home to check on the patient. She says using community outreach workers "could be quite effective" in seeing how the patient is progressing as well as continuing the education on self-care started in the hospital. Here, too, she says the controversial topic of creating a "medical home" is important for patients who don't have primary care physicians.
A recent study in the New England Journal of Medicine, "Rehospitalizations among patients in the Medicare fee-for-service program," is getting a lot of press and attention, and was the subject of a webinar presented by The Commonwealth Fund. That organization's vice president, quality improvement and efficiency, Anne-Marie Audet tells Hospital Peer Review why readmission rates should be one of your top priorities.Subscribe Now for Access
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