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Data hold the key to low readmit rates
With The Joint Commission incorporating the Centers for Medicare & Medicaid Services' (CMS) 30-day readmission rates for heart attack, heart failure, and pneumonia Medicare patients into its Quality Check web site (www.qualitycheck.org), the performance of individual facilities will come under greater scrutiny. Additionally, health care reform legislation might include penalties for poor performance.
As a first step toward decreasing readmission rates, examine your data, says Margaret VanAmringe, MPH, vice president of public policy and government relations in the Washington, DC, office of The Joint Commission. "Look at readmissions and discern whether there are opportunities to reduce the number," she advises. "That will, of course, depend on disease category, population, age, and many different factors."
It will behoove you "to really analyze readmissions, assess these data, use a random sample of charts, and look to see if there is a certain group of patients in these three areas where you feel there could be the potential to prevent readmissions," VanAmringe says.
Michael C. Choo, MD, MBA, FACEP, FAAEM, ACHE, president and CEO of Clinton Memorial Hospital in Wilmington, OH, says, "It's always been very important to evaluate the data on a monthly basis and find solutions." Choo, who served for 10 years as the ED medical director at Dayton Heart Hospital, is bringing what he learned there to his new position. "Congestive heart failure is the most difficult of the three because it's especially problematic in [the Medicare] population," he says. "Initiatives we've used include trying to identify at the time of discharge those patients who need extra support at home or additional education." For those patients who are identified as high-risk, arrangements are made for intense home health care followed by outpatient therapy sessions, he says. His current health system has congestive heart failure clinics, where patients' status is monitored to make sure they stay stable and don't return to the ED or the hospital, he says.
Myocardial infarctions and pneumonia are much easier, he says. "At the time of discharge, we make sure to assess the risk for return, such as home situation compliance probabilities, and communicate those risks with the primary care physician," Choo says. If the patient qualifies, he adds, home health care is recommended.
In the end, says Choo, "it comes down to how well you work with case managers. They identify the risks and coordinate discharge planning, education, and follow-up so the condition does not exacerbate." He has become "much more aggressively proactive in managing these issues," and, in fact, has begun placing case managers within the ED.
With sites such as Quality Check and Hospital Compare, VanAmringe adds, there also is a definite opportunity for benchmarking and for contacting facilities that are performing well and comparing notes. "Health care providers are very interested in comparing how they're doing, and what percentile they're in, compared either with similar facilities or those, say, in the same state," she says. "Being able to benchmark and compare is a very important aspect of quality improvement."