A Community-Wide Quality Improvement Project on Patient Care Transitions Reduces 30-Day Hospital Readmissions From Home Health Agencies

Abstract

Approximately 1 in 5 Medicare patients are rehospitalized within 30 days of discharge. The Harlingen Hospital Referral Region, an area defined by the Dartmouth Atlas as 35 ZIP codes in South Texas, reduced 30-day hospital readmission rates and associated costs through its participation in the Centers for Medicare & Medicaid Services Care Transitions project. The project emphasized a community-wide focus on 4 quality improvement areas: (a) the problem of rehospitalization, (b) improving cross-setting collaboration, (c) access to performance data, and (d) implementation of best practice interventions to reduce avoidable hospitalizations.

Frontloading and Intensity of Skilled Home Health Visits: A State of the Science

“…Sample sizes among the studies varied between 84 patients, using only one home health agency (Rogers et al, 2007), and 74,580 patients using a national data set (Madigan et al, 2012). One study did not report number of patients (Markley et al, 2012). We included the findings from the visit intensity studies as they contribute to the home health literature and extend our knowledge regarding how home health visit intensity relates to patient outcomes (Table 1).…”

“…Two of the seven published studies reviewed investigated frontloading among skilled home health patients (Markley et al, 2012; Rogers et al, 2007). Both studies were prospective and utilized convenience samples.…”

“…Due to this low number of studies, Scopus was then employed to search for additional studies that have cited the original seminal work of Rogers et al (2007). A total of 10 publications have cited Rogers and colleagues’ (2007) study providing three additional studies for inclusion in this review (Madigan et al, 2012; Markley, Sabharwal, Wang, Bigbee, & Whitmire, 2012; Riggs, Madigan, & Fortinsky, 2011). Seven of the 10 articles that cited Rogers and colleagues (2007) were not research studies designed to further our understanding of the impact of frontloading.…”

The Family Perspective on Hospital to Home Transitions: A Qualitative Study

“…This red-flags concept, a type of educational strategy, is well described in adult studies. 8,[53][54][55] Others have came back. But I would just take the more information, the better to prevent…you know things to prevent it from coming back.…”

An environmental analysis of the evolution of readmission reduction strategies: A study of United States hospitals

“…[18] Community care transition programs have also demonstrated effectiveness in reducing readmissions. [19,20] Several studies in 2012 and 2013 discuss the efficacy of potentially preventable readmission software that performs quantitative analysis to lower readmission rates. [21][22][23] Other researchers discuss robust data sharing, information systems sharing, analytical support, care management and joint strategic planning to improve outcomes.…”