Helping You Avoid Return Trips to the Hospital
By Carolyn M. Clancy, M.D.
September 4, 2012
or a loved one has ever been in the hospital for a serious condition, the last
thing you want is a fast return trip.
that's what happens to 1 in 5 patients covered by Medicare, the health
insurance program for people 65 and older, a major study found. Hospital readmissions
within 30 days are costly for Medicare and for patients. These readmissions
total about $17 billion each year. Being readmitted to the hospital can also
slow down a patient's ability to recover or cause new problems.
news: We know how to prevent many readmissions. And we have tools to help
hospitals do a better job.
next month, Medicare will prod hospitals to improve their practices. Hospitals
with high readmissions for three conditions (heart attack, pneumonia, and heart
failure) will get paid less than hospitals with fewer preventable readmissions.
many older patients need to go back to the hospital so soon after they've left?
them are high-risk patients. They may be frail, have chronic conditions, or be
unable to get to their follow-up medical appointments.
reason is that hospitals tend to transfer patients to less costly settings once
their condition is stable. Getting follow-up care at a skilled nursing facility
or at home is a good option, and one many patients prefer. But this care needs
to be carefully managed, so things like medical tests or appointments are
that goal, nearly 50 groups around the country have begun working to improve
the care for high-risk Medicare patients leaving the hospital. The Community-based Care Transitions
Project draws on the experience of local
groups such as the Area Agencies on Aging, the Visiting Nurses Association, and
others. This project was created under the Affordable Care Act.
addition, research funded by the Agency for Healthcare Research and Quality
(AHRQ) has been used to create tools that help hospitals reduce readmissions.
example, a project at Boston University Medical Center called Project RED found
that patients who left the hospital knowing how to deal with their after-care
needs were less likely to be readmitted or to go to the emergency room later.
elements of Project RED include—
- Educating patients about their diagnosis while they're in the hospital.
- Making appointments for needed follow-up tests.
- Making sure patients understand how to take their medicines.
- Calling patients two to three days after they leave the hospital to address any problems.
than 260 hospitals now use parts or all of Project RED to prevent readmissions.
for patients developed by AHRQ called Taking
Care of Myself: A Guide for When I Leave the Hospital is based on the findings from
Project RED. It gives patients an easy-to-understand plan for what to do when
they leave the hospital. The guide is available in English and Spanish.
program educates patients and families about using medicines correctly when patients
leave the hospital.
Project BOOST (Better Outcomes for Older
adults through Safe Transitions) also helps hospitals and outpatient settings
work together on patients' care plans.
patients improve their health once they leave the hospital is not easy or
automatic. The new effort by hospitals to prevent readmissions is a big step in
the right direction. You can help by learning what you should do when you or
your loved ones are in the hospital.
Carolyn Clancy, and that's my advice on how to navigate the health care system.
for Healthcare Research and Quality
Care of Myself: A Guide for When I Leave the Hospital
RED (Re-Engineered Discharge)
Hospital Discharge Through Medication Reconciliation and Education
Care Transitions Program: Centers for Medicare and Medicaid Innovation
SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the
Medicare Fee-for-Service Program. N Engl J Med 2009; 360:1418-1428.
Current as of September 2012
Helping You Avoid Return Trips to the Hospital. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, September 4, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc090412.htm