There is substantial variability in hospital practices to reduce readmissions of patients with heart failure (HF) or acute myocardial infarction (AMI), according to a study recently published in the Journal of the American College of Cardiology, suggesting opportunities for further education around successful best practices, particularly in the areas of medication adherence and post-discharge medication therapy management.
"We have opportunities to improve medication management, with hospitals rarely connecting with outside pharmacies and commonly failing to formally assign responsibility for medication reconciliation," said author Harlan M. Krumholz, MD, professor of medicine, Yale School of Medicine.
"Given that medication errors are rampant, it is likely that a focus on communication and responsibility around medication issues - particularly when patients have had their regimens changed or the hospitalization has led to temporary substitution for their medications - might avoid problems and improve patient outcomes," he said.
"Réadmissions are among the lowesthanging fruit in healthcare cost-reduction, and have remained in the forefront of policy change and quality improvement initiatives for several years," said Stever Aubrey, CEO, Dovetail Health, a readmission prevention company in Needham, Mass. "Despite this fact, we have seen Me to no improvement in readmissions nationwide. In order to change outcomes, we must be willing to change the way we intervene. There is certainly no single approach that will prevent all unnecessary readmissions; however there are proven solutions that can work together to make a significant impact. We know that medications can present significant risks postdischarge, especially with the highest-risk patients. The role of the pharmacist, and in particular the pharmacist care manager, is critical in helping to i^uoe readmissions and improve patient care."
Over the past several years, healthcare reform and related initiatives have placed increased emphasis on the need to prevent hospital readmissions. "Today, the incentives to help reduce readmissions are aligned across stakeholders as they have never been before," Aubrey said. "For the first time we are starting to see health plans, providers, and hospitals all working toward this common goal; and as a resuit, there are a number of programs and models being tested around the country."
Hospital to Home survey
To gain insight into key hospital practices for readmissions reduction, a survey was conducted among 5 37 hospitals partiäpating in Hospital to Home (H2H), a quality improvement initiative developed by the American College of Cardiology (ACC) and the Institute of Healthcare Improvement. H2H was initiated in 2009 to support the nationwide effort to reduce readmission rates for patients with HF and AMI. H2H's first goal was to build an onüne learning community of individuals and facilities committed to reducing readmissions through sharing lessons learned. The study surveyed this H2H community.
"Since then, H2H's next goal was to equip the community with best practices and tools to be successful," said MaryAnne Elma, MPH, director, quality innovation and implementation, Science and Quality Division, ACC. 'This was done through a series of H2H challenge projects focused on one evidence-based improvement area and includes three webinars and a toolkit of strategies and tools distilled from the H2H community."
The JACC study focused on "quality improvement resources and performance monitoring; medication management efforts; and discharge and follow-up processes." Ten specific practices were evaluated across each of these three key areas.
Almost all the hospitals reported tracking the rate of 30-day readmissions. In addition, two-thirds of the hospitals surveyed reviewed unplanned readmissions occurring within 30 days of discharge. Close to 90% of participating hospitals reported that they had a written objective focused en reducing readmissions for HF and AMI patients and, according to the study, "most hospitals reported having a reliable process to identify patients with heart failure at time of readmission. …