JANUARY 17, 2012

Welcome to the Medicare Readmissions Update eNewsletter
This issue sponsored by the Population Health and Care Coordination Colloquium

Treatment Guidelines Keep Readmission Rates Low
UPMC Hamot, Lancaster (PA) General Hospital, and Muncie, IN-based Indiana University Health Ball Memorial Hospital have readmission rates that beat Medicare's HospitalCompare dataset national average in three key areas: 30-day readmission rates for heart attacks, 30-day readmission rates for heart failure, and 30-day readmission rates for pneumonia. There is a common thread tied to each organization's success: detailed treatment guidelines. (HealthLeaders Media - January 13, 2012)

Programs Bridge Gap In Care Between The Hospital and Home
In 2013, Medicare will begin to penalize hospitals that have high rates of preventable readmissions. Hospitals, strongly averse to the prospect of lost income, are paying more attention to this tenuous phase of patient recovery. Increasingly, they are enlisting pharmacists to fill some of the gaps in care that can lead to medication errors and noncompliance with drug regimens. (Pharmacy Practice News - January 2012)

High STEMI Readmission Rate in US Linked to Shorter Hospital Stays
In an analysis of data from more than 15 countries that included the U.S., Canada, Australia, and many European nations, patients in the U.S. who experienced a ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) were more likely to be readmitted to the hospital at 30 days after the heart attack than patients in other countries, according to a study in the January 4 issue of JAMA. (Forbes - January 4, 2012)

Hospital Readmission Rates After Stent Procedures Disturbingly High
A New York State study of 40,000 patients getting stents inserted to open up blocked arteries found that almost one in six of them were readmitted to the hospital within a month of the procedure, often for heart conditions and chest pain. That's higher than the rehospitalization rate of one in 10 stent patients reported at a single Minnesota hospital in a study published last month. (The Atlantic - December 25, 2011)

Nurse Intervention Aims to Reduce Readmissions
Despite improving the discharge process, a December Journal of Hospital Medicine study found that adding a nurse practitioner (NP) to a care team doesn't decrease patient readmissions. None-the-less, medical facilities in Florida and New Jersey are focusing on nurse intervention and communication as ways to lower readmissions and have met with some success. (FierceHealthcare - January 11, 2012)

Pediatric Readmissions Differ from Adult Readmissions
Pediatric readmissions are quantitatively and qualitatively different from adult readmissions. This study provides one of the more comprehensive pictures of readmissions to a children's hospital. Although the data are limited by an inability to account for readmissions to and from other facilities, they nonetheless clearly differentiate pediatric readmissions from those in an adult population. (The Hospitalist - January 2012)

Completed Discharge Summaries Reduce Readmission Risk
Complete and timely discharge summaries can help prevent readmissions and improve patient safety, suggests a study published in the Journal of General Internal Medicine. Joint Commission-accredited organizations must submit discharge summaries within 30 days after a hospital discharges a patient. Researchers at the University of Wisconsin School of Medicine and Public Health, however, found that reports from hospitals to nursing homes often are incomplete or delayed. In fact, as more time passed, the quality of the discharge summary degraded, failing to include the important information on diet, activity level, therapy and pending laboratory tests. (FierceHealthcare - December 22, 2011)

Flagstaff Hospital Using Remote Patient Monitoring
A hospital that draws patients from across northern Arizona, including the Navajo and Hopi reservations, is in the midst of a yearlong pilot project aimed at a population that often skips regular checkups or lacks the money or transportation needed to get prescription medication. It also is trying to limit readmissions because of an upcoming federal rule that financially penalizes hospitals if people are readmitted for certain conditions within 30 days. (Almogordo Daily News - January 15, 2012)

Readmissions News

Watch for the premier, sample issue of Readmissions News in mid January 2012, with the first regular monthly issue commencing in March, 2012. The upcoming Sample issue will be full-length, with twelve pages incorporating all the standard features to be included in every issue of Readmissions News.

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The Readmissions Landscape - Getting the Metrics and Management of Preventable Hospitalizations Right

Stephen Jencks, MD, MPH
Independent Consultant, Washington, DC