Organizational Changes Help to Reduce Hospital Readmissions.
Since the federal government cracked down on hospitals readmitting patients within 30 days, hospitals across the country have adopted a variety of clinical practices, such as scheduling follow-up appointments before discharge, aimed at reducing readmissions.
But a new study co-authored by School of Public Health researchers suggests that certain “organizational practices” may be more effective in reducing readmission rates.
The study, in the journal Medical Care, finds that high-performing hospitals were distinguished by four practices: improving collaboration across disciplinary boundaries; building relationships with post-acute care providers, such as skilled nursing facilities; embracing “trial and error learning”; and fostering a sense that readmissions are bad for patients, rather than worrying about their financial implications.
The federal Centers for Medicare & Medicaid Services imposes financial penalties on about three-quarters of the nation’s hospitals for excessive 30-day readmission rates.
“It seems that adoption of the types of clinical practices that have been widely studied and recommended for readmissions reduction are not sufficient to achieve desired results in all hospitals,” the researchers said. “As has been recognized with other outcomes, the organizational context in which clinical practice changes occur plays an important role in readmissions.”
The research team—which includes James Burgess and Martin Charns, professors of health law, policy & management, and was led by Amanda Brewster (PhD’15)—studied readmission practices in 10 hospitals that were part of the State Action on Avoidable Readmissions (STARR) initiative, a quality improvement collaborative that operated from 2009 to 2013. The researchers interviewed more than 80 hospital staff members about the issue.
They found that some hospitals had established daily multi-disciplinary rounds in inpatient units or made other efforts to improve collaboration.
“Strong coordination across disciplines may be particularly important for mitigating readmissions risk, as information pertinent to the timing of discharge and preparation for post-discharge care resides with different members of the care team,” they wrote.
They also found that some hospitals had invested in “strong relationships” with post-acute providers, even helping those partners to improve their own processes.
The study was led by researchers from the Yale School of Public Health and was supported by The Commonwealth Fund.