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

Abstract

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.

Hospital-level care coordination strategies associated with better patient experience

“…We employed a stratified sampling methodology in which we oversampled hospitals with a high proportion of minority patients and those with particularly high or low performance. This was done to allow us to pursue additional analyses that focused on differences between hospitals that care for a large proportion of vulnerable patients13 and also to examine whether responses varied based on the performance on readmission rates 14…”

Postoperative revisits and readmissions after facelift surgery

“…We acknowledge that the current methodology does not capture return visits to the physician's office, and only includes revisits to outside facilities including the emergency room, the operating room, and inpatient admissions. Therefore, the actual unplanned revisit rate may be slightly higher than reported herein . However, for both the patient and for healthcare utilization, this is an important distinction.…”

“…Revisit rates and the reasons for revisits are also being targeted as an increasingly likely quality and performance measure . Revisit rates and reasons have been examined and reported after ambulatory functional septorhinoplasty, sinonasal surgery, tonsillectomy, and other reconstructive procedures .…”

“…Revisit rates and the reasons for revisits are also being targeted as an increasingly likely quality and performance measure. [4][5][6][7] Revisit rates and reasons have been examined and reported after ambulatory functional septorhinoplasty, sinonasal surgery, tonsillectomy, and other reconstructive procedures. [8][9][10] However, there are few data regarding revisits and readmissions data in the 30-day postoperative period after elective rhytidectomy surgery.…”

Long‐Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a Safety‐Net System

“…Our study takes the perspective of a safety-net delivery system in an environment in which delivery systems, including CHA, are increasingly at risk for the total cost of care through ACOs and other capitated models. While safety-net hospitals may be less likely to utilize strategies for reducing readmission (Figueroa et al 2017), our study demonstrates that investing in strategies like CHW postdischarge transition programs may be a financially viable and cost-effective option. Utilizing CHWs who share a language with patients maybe a particularly efficient means of delivering a postdischarge intervention in a population like ours where a substantial proportion of patients do not speak English; our findings may not generalize to other settings with different language capabilities.…”