How to stop revolving door of hospital admissions

Public health programs and initiatives that aim to lower hospital admission rates may also reduce readmissions, despite the fact that patients in communities that have adopted the programs tend to be sicker when hospitalized.

The federal Centers for Medicare and Medicaid Services has created programs and health improvement strategies to help reduce hospital admissions and readmissions.

However, hospital groups and policymakers worried that these strategies would primarily lower admissions among healthier individuals, resulting in sicker hospital patients with worse outcomes, including higher hospital readmission rates.

Hospitals with high readmission rates face federal penalties.

For the study, published in the journal Health Affairs, researchers used Medicare data for 2010 and 2013, focusing their analyses on communities with hospitals that are major referral centers. For each of these communities, they calculated changes in hospital admission rates and rates of readmission within 30 days after discharge.

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The findings showed a reduction in hospital admissions was strongly associated with a reduction in 30-day readmissions. The results held true despite the fact that the patients ultimately hospitalized in the communities with large reductions in hospital admission rates were sicker on arrival.

“We’re showing that communities can do a good job of improving both population health and outcomes after hospitalization,” says first author Kumar Dharmarajan, assistant professor of cardiology at Yale University. “These goals are not in conflict.”

Strategies that improve community health overall—better care integration, case management, social service support—appear to also improve health after hospital discharge, he says.

While the study results may only pertain to older patients, they strongly suggest that efforts to improve community health and reduce hospital admissions can go hand in hand, without negatively impacting readmissions and health outcomes.

“Doing the right thing for the patient in one setting seems to help in the other setting as well,” Dharmarajan says.

The Centers for Medicare and Medicaid Services supported the work and played no role in designing or conducting the study.

Source: Yale University

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Source: Futurity