Is audit and feedback associated with increased hospital adherence to standards for communication during patient care transitions?

Abstract

Guidelines to enhance communication during patient care transitions between healthcare settings have the potential to improve patient outcomes and satisfaction, as well as to decrease overall costs. In 2009, Healthcentric Advisors, the Medicare Quality Improvement Organization (QIO) for New England, collaborated with Rhode Island providers and stakeholders to develop communitywide standards for hospitals, the Safe Transitions Best Practice Measures for Hospitals and then implemented a hospital quality improvement intervention. As part of this intervention, 10 of the state's 11 acute-care hospitals collected quarterly data and Healthcentric Advisors provided audit and feedback reports showing each facility's progress and the state's average performance. Using hospital-reported data on four best practice measures and Medicare claims data for Q2 2011-Q1 2013, we performed descriptive analyses of (1) inpatient-to-outpatient communication for all patients at the 10 participating hospitals, as measured by four best practice measures, and (2) state-wide all-cause, 30-day readmission rates per 1,000 fee-for-service (FFS) beneficiaries. Aggregate performance for the four best practice process measures increased by 5.5% to 217.6% for all patients who met eligibility criteria (p ≤ .001 for each measure) and the readmission rate decreased by 18.4% from 14.12 to 11.52 per 1,000 eligible FFS Medicare beneficiaries (p ≤ .001). These findings suggest that communitywide standards, such as the Safe Transitions Best Practice Measures for Hospitals, and audit and feedback interventions can successfully improve hospitals' communication during patient care transitions between healthcare settings.

“Why Is This Patient Being Sent Here?”: Communication from Urgent Care to the Emergency Department

“…The Joint Commission also has developed standards for UCCs seeking accreditation, which require that a UCC “manages transitions in care” (8). Because incentives to implement these standards are uncommon, there is an opportunity for commercial health plans to spur uptake of existing guidelines by including these communication practices in their contracts, as has been demonstrated with hospitals in Rhode Island (9). …”

Improving the continuity and coordination of ambulatory care through feedback and facilitated dialogue—a study protocol for a cluster-randomised trial to evaluate the ACD study (Accountable Care in Germany)

“…The sample size estimation based on the assumption of a 20% hospitalisation rate and a 15% reduction in ACSHs following the intervention, we thus expect a 17% ACSH rate in the intervention group. The numbers were chosen after reviewing comparable studies and analysing hospital routine data [ 14 , 25 , 26 ]. With a 5% significance level and a power of 80%, 2629 patients per group would be needed to show this effect (2-sided χ 2 test).…”