Many hospitals in a readmission reduction initiative do not implement some of the recommended strategies to reduce readmissions, according to a study in the Journal of Hospital Medicine.
Researchers studied the readmission reduction strategies used by hospitals in one of two initiatives: the State Action on Avoidable Rehospitalization initiative and the Hospital-to-Home campaign. STAAR, led by the Institute for Healthcare Improvement, is a state-based program designed to foster collaboration among state-level leaders, providers and other community organizations to reduce readmissions. H2H, led by the American College of Cardiology and IHI, is a national project that provides hospitals with strategies and tools to reduce unnecessary readmissions among patients with heart failure or acute myocardial infarction.
From November 2010 through June 2011, researchers surveyed hospitals that had enrolled in H2H or STAAR from May 2009 through June 2010. Many of the hospitals did not implement strategies recommended by the literature or H2H.
For example, of 532 hospitals participating in H2H, only 53.4 percent had a quality improvement team devoted to reducing readmissions for patients with AMI. Of 55 hospitals in STAAR, only 52.7 percent used this strategy. These results suggest room for improvement in hospitals in these initiatives, according to the authors.
When controlling for region and hospital ownership type, STAAR hospitals were more likely than H2H hospitals to use two strategies:
• Ensure outpatient physicians were alerted within 48 hours of patient discharge — 63 percent of STAAR hospitals vs. 38 percent of H2H hospitals.
• Provide skilled nursing facilities with the direct contact number of the inpatient treating physician for patients transferred — 53 percent of STAAR hospitals vs. 34 percent of H2H hospitals.
In contrast, H2H hospitals were more likely than STAAR hospitals to use these two strategies:
• Usually or always assign responsibility for medication reconciliation to nurses — 80 percent of H2H hospitals vs. 54 percent of STAAR hospitals.
• Give most or all discharged patients referrals to cardiac rehabilitation services — 59 percent of H2H hospitals vs. 41 percent of STAAR hospitals.
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