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Some hospitals are implementing more in-depth patient interviews on readmission, seeking to collect more and better data that can help identify quality issues that might be addressed. But these interviews are time- and resource-intensive, so do the results justify the investment?
They can be, if you make good use of the resulting data, says Donna Hopkins, MSN, RN, CMAC, vice president with Novia Strategies, a healthcare consulting firm based in Poway, CA. Historically, hospitals have looked at readmissions by diagnoses, with anecdotal reasons for readmissions and without patient-specific reasons as to why the readmission occurred. That produces data that is of limited value.
A better approach is for hospitals and health systems to develop and implement risk stratification checklists and in-depth patient questionnaires, she says. Readmission-risk criteria can be easily extracted by data in the electronic medical record such as patient visit history, polypharmacy, and comorbid diagnoses, she says. Those can trigger high-risk identification and flow into the daily census used by clinicians.
In addition, nursing and case management can use in-depth questionnaires for deeper dives and interviews to determine actual reasons for readmission. Many of those reasons will be not be clinical, Hopkins notes, related instead to issues such as having no electricity at home, unfilled prescriptions, or no transportation.
“Unfortunately, the operational flaw has been that hospitals are sometimes unsure what to do with the information, either for an individual patient or in the aggregate for a patient population, in order to ensure interventions and access to ambulatory or community connections are available,” she says. “Without an enterprise-wide strategy and available resources to employ outside of the acute care organization, it is not unusual to see a ‘so what?’ attitude about these tools and readmission data.”
With drivers, such as Medicare Spending per Beneficiary and the Quality Improvement Organization renewing their focus on readmissions in the 11th Scope of Work, Hopkins says hospitals are beginning to see an increase in collaborative efforts. Many healthcare systems are even proactively collaborating with needed resources such as transportation, home modifications, and access to nutritional food sources, she says.
Deep-diving into readmission interviews may not address the true problem, says Bryan R. Cote, managing director of the Berkeley Research Group in New York City. There is nothing wrong with gathering more data, but there can be other problems no amount of interviewing will solve, he says.
“Often hospitals won’t even know that they’re dealing with a readmission, that the patient has been there in the past 30 or 60 days, unless a caregiver recognizes the patient and says so. And if they were at another hospital, that’s even harder to know,” Cote says. “The hospital doesn’t know until the patient has been there a while and that night they start looking at records and put the pieces together.”
Identifying the returning patients early should be a goal for any hospital, he says. Readmissions are most common and most costly with heart and lung patients, he notes, and intensive interviews with those patients are unlikely to yield better data.
“I don’t think real-time interviews are the answer at all for that. They’re in a pattern and asking them more questions won’t help,” Cote says. “The real answer is in better documentation and clarity from the hospital to the skilled nursing facility that gives them more clarity, a better picture of this patient. They need to know as much as possible about medications, history, comorbidities, everything under the sun, and they don’t feel like they’re getting that picture in most cases.”