Identifying keys to success in reducing readmissions using the ideal transitions in care framework

Abstract

BackgroundSystematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions.MethodsReview of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework.Results66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0).ConclusionsInterventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-423) contains supplementary material, which is available to authorized users.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial

“…3,5,6,21 While one meta-analysis found no consistent pattern of specific interventions on the efficacy of transitional interventions, 4 a more recent study found that the more domains of an Bideal transition in care^2 2 that were included in the intervention, the more effective it was in reducing readmissions. 23 Especially important were domains of monitoring and managing symptoms after discharge, enlisting the help of social and community supports, and educating patients to promote self-management.…”

Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey

“…While the validity of this approach is partially supported by the finding that readmission reduction programs including more domains from this framework had significantly higher effectiveness, it is nonetheless possible that this categorization scheme failed to sufficiently capture some of the true contributors to readmission. 4 We also did not test inter-rater reliability, test-retest reliability, parallel-forms reliability, or internal consistency reliability of our survey instrument, a limitation which may have contributed to failure to accurately or reproducibly measure the constructs in which we were interested. While gaps in psychometric testing of our surveys may have limited accuracy in factor identification by individual physicians, it is less clear how this limitation might have effected physicians differentially and, in turn, how and whether it might have impacted our findings regarding concordance of viewpoints, particularly when physicians did not appear to have difficulty in identifying at least one contributor in each case.…”

“…1 Despite widespread efforts using a variety of approaches for reducing readmissions, the effects of readmission reduction programs have been equivocal. [2][3][4][5] In addition, debate continues on the preventability of hospital readmissions, with a systematic review estimating that as few as 27 % of readmissions are truly preventable. 6 The high rate of hospital readmissions and uncertain effects of readmission reduction programs may, in part, stem from incomplete understanding of the reasons for readmission or Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3764-5) contains supplementary material, which is available to authorized users.…”

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

“…This study found that monitoring symptoms after discharge, providing social and community support, and educating patients to promote self-management helps reduce readmissions. [29] A study at Kaiser Permanente hospitals demonstrated that manual chart reviews were more effective at reducing readmissions than automated classifications done by technical software programs. [30] Researchers studied nursing home residents and found that the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program for identification, evaluation, and management of acute changes in the condition of nursing home residents can be expected to reduce readmission rates.…”