MANAGED CARE February 2009. ©MediMedia USA
High quality post-hospital orders can cut readmissions by 30 percent. Medical administrators may soon insist on it.
Patients who have a clear understanding of their after-hospital care instructions, including how to take their medications and when to make follow-up appointments, are 30 percent less likely to be readmitted or to revisit the emergency department than patients who lack this information.
Fewer readmissions and emergency department visits mean lower total costs. According to a new study funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the Feb. 3 Annals of Internal Medicine, total costs (a combination of actual hospitalization costs and estimated outpatient costs) were $412 (33 percent) lower for patients who received complete information than for those who did not.
That’s a significant saving to insurers, but not necessarily an incentive to hospitals, says Brian W. Jack, MD, of Boston University Medical Center’s Department of Family Medicine, the lead author of the study. “This definitely decreases hospital utilization,” says Jack.
The research team developed a multifaceted program to educate patients about their post-hospital care. Called the Re-Engineered Hospital Discharge Program (RED), the program used specially-trained nurses to help one group of patients arrange follow-up appointments, confirm medication routines, and understand their diagnoses using a personalized instruction booklet. A pharmacist contacted patients between two and four days after discharge to reinforce the medication plan and answer questions.
Thirty days after discharge, the 370 patients who participated in the RED program had incurred 30 percent fewer emergency visits and re-admissions than the 368 patients who did not. Participants in the RED program were also more likely to have a follow-up appointment with their primary care physician and say they were prepared for leaving the hospital than non-participants, according to the study findings.
Nearly all (94 percent) of the patients in the RED program left the hospital with a follow-up appointment with their primary care physician, compared to 35 percent for patients who did not participate. More than half (53 percent) of participants had their updated medications included in their post-hospital care plan, and nearly all (91 percent ) had their discharge information sent to their primary care physician within 24 hours of leaving the hospital.
Making post-hospital care available to patients did not prevent medication problems from occurring, the study noted. Sixty-five percent of the RED program participants who completed the medication review with the pharmacist had at least one problem with their drugs. In half of those cases, the pharmacist needed to take action, such as contacting the patient’s doctor.
“Patients are sometimes placed in a difficult and complex situation upon discharge,” says Jack. “Having a pharmacist call a few days later to check on how the medication is working or whether there are any problems with medications can have good results.”
“This program meets all the national accrediting organizations’ best practices guidelines for high quality discharges,” says Jack. “Our research shows that it can decrease the risk of a patient coming back to the emergency room. That’s a major clinical outcome.”
The Centers for Medicare and Medicaid Services (CMS) has a request for proposals for the quality improvement program of each state to develop a new payment structure. Grants have been made to 14 states and “Project RED is being used in 8 of the 14,” says Jack. “The first rollout is occurring in Rhode Island.”