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The Two Sides of the Hospital Readmissions Coin



March 4th, 2013
by Anne Weiss

Anne Weiss is a senior program officer who directs the Robert Wood Johnson Foundation’s Quality/Equality Health Care team.

The Robert Wood Johnson Foundation (RWJF) recently released a new report and convened leading policy makers and other influencers for an important discussion on one of the biggest problems facing our health care system: avoidable hospital readmissions. We’ve known for some time that preventable readmissions are the proverbial “low hanging fruit”: They’re bad for patients’ health, expensive, and burdensome for caregivers and families. Throughout the event, I was struck by how everyone—health professionals, researchers, consumers, and journalists—had a story to tell about a loved one’s perilous transition from hospital to home.

The report and the event revealed two sides of the hospital readmissions coin. On one side, the new report prepared by the Dartmouth Atlas Project is a sobering reminder that, although the problem has been on our radar, we’ve made little progress in reducing hospital readmissions for elderly patients. On the other side, we saw encouraging signs around the country that nurses, care coordinators, front-line providers–and patients and families, especially—are working together to make change happen.

The report and event are part of Care About Your Care, a month-long initiative to focus attention on avoidable hospital readmissions, celebrate how hospitals and communities are working together to improve care transitions, and help patients and families understand the role they can play in their health care. The RWJF sponsored a “Transitions to Better Care” video contest to showcase a wide range of patient-centered approaches to effective care. More than 100 impressive and inspiring videos were submitted; they demonstrated that change is possible when hospitals, patients and families, and local communities work together.

The February 13 discussion at the National Press Club, simulcast on our website, rwjf.org, was the cornerstone of Care About Your Care month. Nancy Snyderman, a physician and chief medical editor for NBC News, joined RWJF President and CEO Risa Lavizzo-Mourey and a panel of national experts to discuss the topic of effective care transitions and share best practices for patient transitions from hospital to home and beyond. You can watch the webcast here.

“We know that there is a lot of promising work going on out there all around the country that can improve the transitions of care and help reduce those readmissions that we all know need to be reduced. The work that we are doing is not just the work of hospitals,” said Lavizzo-Mourey. “It takes everyone. It takes primary care providers; it takes hospitals; it takes caregivers. It takes an entire ecosystem of stakeholders to really reduce hospitalizations.”

The event was well-attended, with more than 300 attendees and more than 2,000 webcast viewers. The audience included frontline care staff and members of more than two dozen public and private partner health care organizations representing hospitals, health care providers, and caregivers; representatives from the RWJF’s Aligning Forces for Quality communities; and patients. There was wide recognition that we can do better and optimism that we can get care right the first time.

There was also uniform agreement that hospitals can’t do it alone— reducing the number of readmissions will take more than offering clear discharge instructions, for example. As our report notes, readmissions occur for many reasons. Fixing this complex problem will require a multitude of different solutions. Both in terms of individual patient care and systemic changes, one size fits none. The replication of best practices is really the reinvention of programs to meet a patient’s needs in his or her own environment.

With this in mind, what can we do moving forward?

“If you involve patients—actually talk to them—patients will tell you what they need to know to reduce those hospitalizations.” said Lavizzo-Mourey. “And they are letting us know that you have to rely on the entire community, bringing in those resources from around the community that can do the things that help people stay at home and stay well.”

“It comes down to the individual nurses and that interaction between the nurse and the patient and the family,” said Margaret Namie, a registered nurse and vice president of quality at Mercy Health in Cincinnati. “We look at what is important—what is the goal of that patient and family—not what we have for them but what they have for themselves. We meet them where they are, and that means coaching, not teaching, through really tough issues.”

Mary Naylor, a registered nurse, Marian S. Ware Professor in Gerontology, and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing, described how different care communities need to adapt their models to accomplish whatever is needed for the patient, given his or her environment.

These are important reminders that avoidable readmissions must be addressed community by community. Health care is delivered locally, and improving it requires local action. As a philanthropy, the RWJF is committed to improving care at the local level through Aligning Forces for Quality, which asks community stakeholders to take specific actions that will lead to better care.

Over and over again, speakers and audience members came back to the point that we have to better engage patients and family members in care. Eric Coleman, a physician, professor of medicine, and head of the division of health care policy at the University of Colorado Anschutz Medical Campus, said improving care will not only take preparing patients, but also working with caregivers so that everyone is on the same page.

Health care providers have “talked the talk” of patient engagement for years. After last month’s Care About Your Care initiative, it is clear to me that hospital readmissions may be the issue that finally forces the health care system to “walk the walk” of patient engagement.

Editor’s Note—related resources:

Health Affairs February 2013 issue: a thematic issue on the “new era of patient engagement.” Read the Table of Contents here.

“Eric Coleman Named MacArthur Foundation Fellow,” by Lee-Lee Prina, October 3, 2012, GrantWatch Blog.

“Improving Care Transitions: A Key Component of Health Reform,” by Eric Coleman (mentioned above) and Amy Berman (of the John A. Hartford Foundation), April 29, 2010, GrantWatch Blog.

 

 

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