A Project to Reengineer Discharges Reduces 30-Day Readmission Rates

Markley, Jennifer; Andow, Vanessa; Sabharwal, K; Wang, Ziyin; Fennell, Emilie; Dusek, Ron

doi:10.1097/01.naj.0000431922.47547.eb

Cited by 22 publications

(14 citation statements)

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“…Despite moves toward earlier discharges, there is increasing pressure from public and private payers to reduce readmissions for an expanding number of admission diagnoses [ 15 , 16 ]. The transition from in-hospital care to home care, and the management of home care, are increasingly recognized as important factors that can influence the rate of readmissions [ 17 ]. Early recognition of complications may allow outpatient management in some cases.…”

Section: Introductionmentioning

confidence: 99%

Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App

Scott¹,

Alore²,

Naik³

et al. 2017

JMIR Mhealth Uhealth

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BackgroundLimited communication and care coordination following discharge from hospitals may contribute to surgical complications. Smartphone apps offer a novel mechanism for communication and care coordination. However, factors which may affect patient app use in a postoperative, at-home setting are poorly understood.ObjectiveThe objectives of this study were to (1) gauge interest in smartphone app use among patients after colorectal surgery and (2) better understand factors affecting patient app use in a postoperative, at-home setting.MethodsA prospective feasibility study was performed at a hospital that principally serves low socioeconomic status patients. After colorectal surgery, patients were enrolled and given a smartphone app, which uses previously validated content to provide symptom-based recommendations. Patients were instructed to use the app daily for 14 days after discharge. Demographics and usability data were collected at enrollment. Usability was measured with the System Usability Scale (SUS). At follow-up, the SUS was repeated and patients underwent a structured interview covering ease of use, willingness to use, and utility of use. Two members of the research team independently reviewed the field notes from follow-up interviews and extracted the most consistent themes. Chart and app log reviews identified clinical endpoints.ResultsWe screened 115 patients, enrolled 20 patients (17.4%), and completed follow-up interviews with 17 patients (85%). Reasons for nonenrollment included: failure to meet inclusion criteria (47/115, 40.9%), declined to participate (26/115, 22.6%), and other reasons (22/115, 19.1%). There was no difference in patient ratings between usability at first-use and after extended use, with SUS scores greater than the 95th percentile at both time points. Despite high usability ratings, 6/20 (30%) of patients never used the app at home after hospital discharge and 2/20 (10%) only used the app once. Interviews revealed three themes related to app use: (1) patient-related barriers could prevent use even though the app had high usability scores; (2) patients viewed the app as a second opinion, rather than a primary source of information; and (3) many patients viewed the app as an external burden.ConclusionsUse patterns in this study, and response rates after prompts to contact the operative team, suggest that apps need to be highly engaging to be adopted by patients. The growing penetration of smartphones and the proliferation of app-based interventions are unlikely to improve care coordination and communication, unless apps address the barriers and patient perceptions identified in this study. This study shows that high usability alone is not sufficient to motivate patients to use smartphone apps in the postoperative period.

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Section: Introductionmentioning

confidence: 99%

Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App

Scott¹,

Alore²,

Naik³

et al. 2017

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

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“…Many have focused on methods that can be grouped into predischarge, postdischarge, and bridging strategies. 16 Commonly, the focus is on patient education, timely follow-up, and coordination with both primary care physicians and skilled nursing care, [16][17][18] and showed promising early results. Another recent report showed that a 24-hour consultation phone service for TJA patients can reduce the number of ED visits in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Use of a Mandatory Clinical Decision Unit Reduces Readmission Rates following Total Joint Arthroplasty

et al. 2020

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Readmission penalties have encouraged the implementation of protocols to reduce readmission rates. We hypothesized that by keeping postoperative patients, who return to the emergency department (ED) in a clinical decision unit (CDU) until being evaluated by the orthopaedic team, there would be a reduction in the readmission rate after total joint arthroplasty (TJA) at our institution. Our institution mandated the use of the CDU for all potential orthopaedic TJA readmissions. A retrospective review of prospectively collected data was performed on 365 patients who presented to the ED after either total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients presenting in the year prior to the implementation of the CDU program were compared with patients presenting in the year after implementation. Demographics, length of stay, comorbidities, and 30-day readmission rates were recorded. Additionally, a financial analysis was performed. Overall, for THA and TKA, there were a combined 141 ED visits prior to the implementation of the CDU program and 224 afterward; of these, 40 were readmitted before the CDU program and only 13 were readmitted afterward (p < 0.01). The financial analysis found that the overall 90-day cost for patients in the postoperative period was nearly $800 lower on average (p = 0.027) post-CDU implementation.During the first year of the CDU project at our institution, we significantly reduced the readmission rates following TJA and demonstrated significant cost saving. This is a Level III, prognostic study.

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“…In a clinical trial of over 700 patients, patients assigned to Project RED (versus usual care) had a significantly lower rate of emergency department visits and hospitalizations within 30 days (incidence rate ratio 0.7, p=0.009) 56 Implementation of Project RED components in another setting was associated with a reduction of readmission rates (relative reduction: 36% at 30 days, compared to historical data). 66 …”

Section: Evidence-based Programs To Reduce Hospital Readmissionsmentioning

confidence: 99%

National COPD Readmissions Summit 2013: Integrating COPD into Patient-Centered Hospital Readmissions Reduction Programs

Krishnan¹,

Gussin²,

Prieto-Centurion³

et al. 2014

J COPD F

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About 1 in 5 patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in the United States are readmitted within 30 days. The U.S. Centers for Medicare and Medicaid Services has recently expanded its Hospital Readmissions Reduction Program to financially penalize hospitals with higher than expected all-cause 30-day readmission rates following a hospitalization for COPD exacerbation. In October 2013, the COPD Foundation convened a multi-stakeholder National COPD Readmissions Summit to summarize our understanding of how to reduce hospital readmissions in patients hospitalized for COPD exacerbations. Over 225 individuals participated in the Summit, including patients, clinicians, health service researchers, policy makers and representatives of academic health care centers, industry, and payers. Summit participants recommend that programs to reduce hospital readmissions: 1) Include specific recommendations about how to promote COPD self-management skills training for patients and their caregivers; 2) Adequately address co-existing disorders common to COPD in care plans during and after hospitalizations; 3) Include an evaluation of adverse events when implementing strategies to reduce hospital readmissions; and 4) Develop a strategy (e.g., a learning collaboratory) to connect groups who are engaged in developing, testing, and implementing programs to reduce hospital readmissions for COPD and other conditions.

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A Project to Reengineer Discharges Reduces 30-Day Readmission Rates

Abstract: A Texas hospital achieves improvement in its readmission rate by implementing Project RED.

Cited by 22 publications

References 0 publications

Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App

Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App

Use of a Mandatory Clinical Decision Unit Reduces Readmission Rates following Total Joint Arthroplasty

National COPD Readmissions Summit 2013: Integrating COPD into Patient-Centered Hospital Readmissions Reduction Programs

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