Investigating hospital readmission reduction efforts

Reducing avoidable readmission—patients returning to the hospital within 30 days following discharge—has become a growing concern for hospitals over the past several years. Readmissions signal that a health condition has not been properly managed after discharge and are often associated with poorer health outcomes and increased health care costs.

Despite efforts to incentivize readmission reduction efforts, most U.S. hospitals participating in the Centers for Medicare and Medicaid Services programs face financial penalties for not reaching their avoidable readmission targets. Researchers have investigated readmission reduction efforts, but these studies have had limited scope, such as looking at specific conditions or patient groups, and have been light on details about actual implementation of effective reduction strategies.

In a new study published in the American Journal of Medical Quality, a research team led by Bita Kash, PhD, professor in the Health Policy and Management Department at the Texas A&M School of Public Health and director of the Center for Outcomes Research at Houston Methodist Research Institute, reviewed published studies of hospital readmission reduction interventions and analyzed the impact of various strategies on readmission rates, evaluating their implementation at two leading hospitals, Houston Methodist and the University of Texas MD Anderson Cancer Center. By analyzing these strategies and comparing them with results from published studies, Kash and colleagues intended to better understand what interventions are most effective in avoiding hospital readmissions and how best to implement them in a real-world setting.

The researchers first carried out a systematic review of 4,886 articles on readmission reduction published between January 2006 and January 2017. They included articles on hospital reduction interventions and were concerned with 30-day readmission rates that also performed statistical analyses and had statistically significant readmission reduction results. In the selected studies, Kash and colleagues investigated intervention and disease types, intervention settings and timing, and the role of health information exchanges. Along with their systematic review, the researchers surveyed employees at both hospitals to find which readmission reduction interventions were most commonly used.

After comparing the survey results with findings from the review of literature, Kash and colleagues found that the most commonly reported interventions at the two hospitals agreed with those noted in the literature. The six most reported interventions to reduce readmissions were identified as collaborations/coordination with other clinical teams, primary care physicians or community-based programs, patient/family education, telephone follow-up appointment and discharge planning.

Additionally, although the survey results were consistent with the body of research on hospital readmission reduction, there were some variations between the hospitals in how interventions are implemented. The researchers state that this is likely related to available resources and how they are used at different institutions.

This study serves as an initial look into which readmission reduction practices work and how they are implemented. However, Kash and her colleagues note some limitations to the work. Further research into how timing and structure of interventions affect readmission rates will be needed. Also, this study only reviewed studies showing successful readmission reduction efforts. Future studies should include the evaluation of interventions that negatively affect readmission rates to give researchers more evidence on what works and what does not.

Having a better understanding of how theory and implementation align gives a more detailed view of how to best put different interventions in place to reduce hospital readmissions.

“This knowledge will help hospital leaders and providers reduce hospital readmissions by giving them insight into how leading hospitals implement most effective strategies identified in this paper,” Kash said. “Having better interventions would improve patient care and reduce costs to patients and hospitals alike.”