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    Ten ways to reduce hospital readmissions


    Irvine, California-based ConcertoHealth serves its patients, 97% of whom are eligible for Medicare and Medicaid, at four care center locations in Detroit and three care centers in Seattle. Through discharge planning and post-discharge support infrastructure, use of technology, and "embedding" clinicians with admitting privileges at area hospitals' emergency departments, the healthcare system has reduced readmissions within one year of admission from more than 25% to less than 15%. It has also decreased average lengths of stay from almost 30 days to less than 15 days, says Colin LeClair, senior vice president of business and product development at ConcertoHealth.

    LeClairLeClairThe health system uses technology from Boston-based PatientPing that alerts staff in Irvine if a patient presents in an emergency room in Detroit or Seattle. At that point, embedded clinicians employed by ConcertoHealth, either nurses or physicians who provide coverage for two or three hospitals, take over the patients' care in the emergency room. That involves actually meeting with the patient and communicating with the hospital about the patient’s primary care provider, relevant specialists, care manager, and their medical history, all with the goal of reducing readmissions and getting the patient into the appropriate care setting. That care setting might be a skilled nursing facility or in-home care supported by a home health agency, for example, says LeClair.

    Here are nine other strategies providers across the country are using to reduce hospital readmissions.

    1. Increasing patient engagement 

    If healthcare providers wait until the day of a patient's hip or knee surgery to worry about preventing readmissions, they've probably missed the boat, says Anthony DiGioia, MD, founder and medical director of the Patient and Family Centered Care Methodology and Practice Innovation Center at the University of Pittsburgh Medical Center (UPMC).

    DiGioiaDiGioiaThat's why the medical center considers all of the processes that touch patients, from presurgical preparations such as lab testing to the surgery and the patient stay to the patient's rehabilitation, and keeping in mind the perspective of patients and their families as they design patient care. Keeping the patient's perspective in mind helps drive higher patient engagement, which, along with family engagement, is the best way to reduce readmissions and improve outcomes, insists DiGioia, who is also a practicing orthopedic surgeon.

    DiGioia notes that patient falls, either in the hospital or at home after surgery, are of particular concern to patients and their friends and families. In response, UPMC uses the following approach, which is heavily reliant on patient engagement, to help prevent readmissions among its total hip and total knee replacement patients:

    • Educating patients three or four weeks before their surgery about what to expect;

    • Coaching patients to start their post-operative exercises three or four weeks before their surgery;

    • Teaching patients about the medical center’s falls prevention program; and

    • Encouraging patients to select a family member or a friend as a "coach."

    At 4.8%, three of the 20 hospitals under the UPMC umbrella chosen at random, Magee-Womens Hospital of UPMC Health System, UPMC Presbyterian Shadyside, and UPMC Mercy, are at the national rate of unplanned readmission rate after hip/knee surgery, according to the Hospital Compare website.

    Next: Preventing surgical site infections


    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...


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