Challenges in Reducing Readmissions: Lessons from Leadership and Frontline Personnel at Eight Minority-Serving Hospitals

Joynt, Karen E.; Sarma, Nandini; Epstein, Arnold M.; Jha, Ashish K.; Weissman, Joel S.

doi:10.1016/s1553-7250(14)40056-4

Cited by 25 publications

(35 citation statements)

References 13 publications

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“…We first conducted a set of case studies examining hospitals’ efforts to improve care coordination and reduce hospital readmissions in light of the recently implemented Hospital Readmissions Reduction Program (HRRP), which has been previously described 15. Based on this work, we developed a survey instrument that was tested with hospital leaders, hospital personnel and survey experts, and revised accordingly 14…”

Section: Methodsmentioning

confidence: 99%

Hospital-level care coordination strategies associated with better patient experience

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Section: Methodsmentioning

confidence: 99%

Hospital-level care coordination strategies associated with better patient experience

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“…(14) As part of this work, we developed a survey instrument that was tested with survey experts, hospital personnel, and leaders. The survey instrument asked questions related to 1) barriers hospitals face in reducing readmissions, including patient-, community-, and hospital-related barriers and 2) strategies hospitals use to reduce readmissions (Supplemental Digital Content 2).…”

Section: Methodsmentioning

confidence: 99%

Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions

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Objective U.S. hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. Design We surveyed leadership at 1,600 U.S. acute care hospitals, of whom 980 participated, between June 2013–January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for non-response and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs. Results We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared to non-SNHs (p-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, p<0.04) or verbally communicate (31.5% vs. 39.8%, p<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, p<0.001), or enroll patients in post-discharge programs (13.3% vs. 17.2%, p<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and post-discharge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies. Conclusions Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the HRRP.

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“…First, safety net hospitals which care for a larger proportion of patients with low socioeconomic status (SES), may find it challenging or costly to address underlying socioeconomic reasons for readmissions, such as homelessness, lack of social support or medication non-compliance. 2 10 12 13 Second, because of their higher readmission rates, 4 14 safety net hospitals have been more likely both to be penalised and to face slightly higher financial penalties under HRRP. 7-9 15 16 These increased penalties may reduce resources to already financially strained institutions, inhibiting their ability to invest in effective transitions of care programmes, leading to less improvement in readmission rates.…”

Section: Open Accessmentioning

confidence: 99%

Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015

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ObjectiveTo compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP).DesignA retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015.SettingWe examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital’s proportion of patients with low socioeconomic status.ParticipantsAdmissions for Medicare fee-for-service patients, age ≥65 years, discharged alive, who had a valid five-digit zip code and did not have a principal discharge diagnosis of cancer or psychiatric illness were included, for a total of 52 516 213 index admissions.Primary and secondary outcome measuresMean hospital-level, all-condition, 30-day risk-adjusted standardised unplanned readmission rate, measured quarterly, along with quarterly rate of change, and an interrupted time series examining: April–June 2010, after HRRP was passed, and October–December 2012, after HRRP penalties were implemented.Results58.0% (SD 15.3) of safety net hospitals and 17.1% (SD 10.4) of non-safety net hospitals’ patients were in the lowest quartile of socioeconomic status. The mean safety net hospital standardised readmission rate declined from 17.0% (SD 3.7) to 13.6% (SD 3.6), whereas the mean non-safety net hospital declined from 15.4% (SD 3.0) to 12.7% (SD 2.5). The absolute difference in rates between safety net and non-safety net hospitals declined from 1.6% (95% CI 1.3 to 1.9) to 0.9% (0.7 to 1.2). The quarterly decline in standardised readmission rates was 0.03 percentage points (95% CI 0.03 to 0.02, p<0.001) greater among safety net hospitals over the entire study period, and no differential change among safety net and non-safety net hospitals was found after either HRRP was passed or penalties enacted.ConclusionsSince HRRP was passed and penalties implemented, readmission rates for safety net hospitals have decreased more rapidly than those for non-safety net hospitals.

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Challenges in Reducing Readmissions: Lessons from Leadership and Frontline Personnel at Eight Minority-Serving Hospitals

Cited by 25 publications

References 13 publications

Hospital-level care coordination strategies associated with better patient experience

Hospital-level care coordination strategies associated with better patient experience

Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions

Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015

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