Value-based purchasing (VBP) has added more weight to the role of quality managers in collecting data related to 30-day readmission rates. These readmission rates now affect a health system’s Medicare reimbursement, and the key is to look at data in a way that will highlight areas where improvements can have a positive effect on them.
One recent study shows that data from patient satisfaction surveys offer clues about changes that can reduce readmissions.1
“My whole angle to this [study] was to draw together the finance with quality and show how quality influences finance through readmissions,” says Jordan Mitchell, PhD, assistant professor of healthcare administration in the school of business at University of Houston Clear Lake in Houston, TX.
“Value-based purchasing is influencing a lot of hospitals’ finance departments now,” he adds. “The way that’s determined is with process measures, outcome measures, and patient-reported measures.”
Mitchell theorized that patient-reported measures involving physician and nurse instructions would influence 30-day readmission rates and influence CBP. His study found that nurse communication, physician communication, and discharge instructions were significant in predicting lower readmissions with discharge instructions being the most influential.1
In other words, the higher the patient ratings of clinician communication and discharge instructions, the lower the 30-day readmission rates, Mitchell says.
The value-based purchasing incentive could be indirectly affected by lowering the 30-day readmission rate, which could be affected by improving provider communication with patients and discharge instructions, he explains.
“For future policy and practical implications, there needs to be a focus on patient-centeredness, especially with electronic health records,” Mitchell says. “Some of the times when hospitals put in electronic health records they will have a stand-alone system, and doctors will face a computer and not a patient; that kills patient communication.”
Future research should look into how doctors can more effectively communicate with patients without the EHR and data input getting in the way, he adds.
“Increasing communication and making sure patients know what to do on discharge are the two items that I think would have the most bang for the buck in lowering readmissions and increasing the value-based purchasing incentive,” Mitchell says.
Quality managers can use similar data to see if their own hospitals need a quality improvement project to improve communication and discharge instructions. For instance, the data Mitchell used came from a national dataset of the patient-reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) quality measures and medical readmissions.1
Mitchell used the following questions:
• How often did nurses/doctors communicate well with you? “I looked at the percent of never, sometimes, or always, and I used always for my data point,” he says.
• With discharge instructions, were you given information about what to do during your recovery? “I used the percent saying ‘yes,’” Mitchell says.
“The discharge instructions explains the most variance in terms of 30-day medical readmits,” he adds.
While the data don’t show a direct cause and effect, the association strongly suggests that when patients feel like they know what to do during their recovery, they are not readmitted within 30 days, he explains.
“Quality managers could compare it with their own hospital, drilling down to their own hospital’s data and, more specifically, to patient level information in the electronic health record,” Mitchell suggests. “With EHRs there’s no excuse not to do that.”
REFERENCE
-
Mitchell JP. Association of provider communication and discharge instructions on lower readmissions. J Health Quality. 2015;37(1):33-40.
SOURCE
-
Jordan Mitchell, PhD, Assistant Professor, Health Care Administration, School of Business, University of Houston Clear Lake, Houston, TX. Email: [email protected].
