Of the total number of hospitalization every year, one in nine is a re-hospitalization, where a patient is, within 30 days of the first hospitalization, readmitted. Some groups of people are more likely than others to be readmitted. A quarter of elderly patients on Medicare patients are readmitted to the hospital within a month of being discharged. It is estimated that the nation readmission rate is around 19 percent.
When the elderly are re-hospitalized it can be very traumatizing. However, these re-hospitalizations are often avoidable. Prior to October 2012 there were very few reasons to keep patients from being re-hospitalized. Now the Centers for Medicaid and Medicare Services (CMS) have started penalizing hospitals that have high readmission rates. There have been nearly 2,000 hospitals in the United States penalized under this new program.
Almost all readmissions are unplanned. The high number of readmissions is often because of poor care coordination and continuity. Less than half of people who are re-hospitalized actually see a physician before being readmitted. Additionally, studies have shown that of Medicare discharges, nearly 20 percent have an adverse event within 30 days. These adverse events are usually due to medication mismanagement. Given that it is the elderly population that is most often re-hospitalized, hospitals who serve this group will likely have the most penalties under the new program to reduce readmissions.
Hospitals need to look at the reasons why Medicare patients are re-hospitalized. One major factor in re-hospitalization of elderly Medicare patients is lack of communication among health care providers involved in a patients care. If there was a greater focus on discharge planning and post-discharge care then the number of preventable readmissions could be reduced, patients outcomes could be improved, and costly Medicare penalties avoided.
One way to reduce readmissions is to improve medication management. Research has shown that 88 percent of emergency hospital admissions among elderly patients result from adverse medication events. Two thirds of these admissions are readmissions. Medication reconciliation methods and proper medication therapy management programs can be used to encourage hospital staff and pharmacists to align prescription therapy and oversee the medication regimens of discharged patients.
Education could also be helpful in reducing the number of readmissions. Lack of education is one of the reasons patients do not take medications as directed. The most effective education programs improve compliance, health literacy, and self-management. They reinforce self-care methods, regular follow-ups over the phone, and visit with a physician within 5-7 days after being discharged.
Physicians should also provide patients with follow-up and monitoring after discharge. There is often a failure of many patients to see a health care provider after they have left the hospital. Home health aides or access to home care services can help improve a patient’s care transition after being discharged. Home care reduces readmissions by providing an inexpensive supplement to medical-based care transitions. Additionally, real-time monitoring of a patients care and health status can help physicians identify issues and allow for early intervention at the patient’s home. This could help reduce acute care visits, emergency room visits, and the need for readmission to hospital.
Taking these types of actions can help patients live at home with greater comfort and at lower costs. This is better not only for patients, but physicians as well. Physicians would have more time and resources to treat other patients when the number of preventable readmission is reduced.
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