Hospitals see fewer readmissions with more options after discharge

Health systems with more primary care physicians and palliative care wards have seen fewer people return to hospital, a new study finds.

Hospitals offering a variety of post-discharge care options are generally more successful in helping patients avoid readmission, a new study finds.

The researchers found that hospitals with more primary care physicians and health systems offering palliative care services had lower 30-day readmission rates. Health systems operating in areas with more skilled nursing facility beds or licensed nursing home beds also saw fewer people returning to hospital within 30 days. The study was published on Tuesday July 5 in Health Affairs.

However, the study also found that hospitals in areas with more home health agencies or nurse practitioners had a higher level of 30-day readmissions.

The authors noted that hospitals could consider providing additional post-discharge care options to serve their patients and avoid the prospect of penalties from the federal government. The Centers for Medicare and Medicaid Services reduce payments to health care systems if they have consistently higher readmission rates.

“Our findings suggest that hospitals could take a more active role in developing post-discharge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and avoid sanctions. “, wrote the authors.

The authors also suggested that hospitals use palliative care services whenever possible.

“The use of palliative care can reduce unwanted and potentially unnecessary medical care for the seriously ill, while patients in areas without sufficient access to primary care or nursing facilities (e.g., isolated rural areas or low-income urban areas) may be forced to return to hospital emergency departments in the event of complications,” the researchers wrote.

Building Community Partnerships

The researchers looked at more than 3,000 hospitals between 2013 and 2019.

Most hospitals were private, not-for-profit providers based in urban areas, the authors said. Most operated a palliative service in a hospital setting. The median hospital in the study had fewer than 200 beds and an average daily count of fewer than 100 patients.

Health systems should seek opportunities to work with other community organizations and agencies to support patients after discharge from hospital.

“Our results suggest that hospitals could benefit from work to improve local access to care or from hospital-community partnerships to improve continuity of care after discharge,” the authors wrote.

Hospitals should look closely at readmission rates from various discharge sites to determine whether patients are doing better in some settings than others and to see where care can be improved.

With higher readmission rates associated with home health agencies, the authors suggest this may reflect a lack of continuity of care due to the high turnover of workers in these agencies.

While a higher rate of nurse practitioners was also associated with a higher likelihood of hospital readmission in this study, the authors noted that nurse practitioners were successful in some interventions in helping patients avoid a return. to the hospital.

The authors hypothesized that a higher concentration of nurse practitioners in an area may be a sign that patients in that area have a higher level of disease or health complications, the authors noted. The link between nurse practitioners and higher readmission rates may also reflect the shortage of other health care resources.

Reconsider the sanctions

The authors said the study has implications for how the federal government should reimburse hospitals.

CMS should reassess some of the ways it looks at health systems to determine whether they should be penalized as part of the hospital readmission reduction program, the authors suggest.

“CMS may also consider risk adjustment for the provision of post-discharge care under the HRRP to avoid penalizing or rewarding hospitals based on the characteristics of the communities they serve instead of the quality. of the care they provide,” the authors wrote.

If the CMS adjusts its risk on the availability of an inpatient palliative care service, it could punish health systems with such services by lowering their readmission targets, the authors said.

Such a move could also deter health systems from launching palliative care services, the authors wrote.

Researchers from Vanderbilt University Medical Center, Veterans Affairs Boston Healthcare System, Washington University in St. Louis and Boston University authored the study.

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