BETHESDA, MD - A recent health policy brief examining the efforts in the U.S. healthcare system to improve care transitions concludes that simple solutions would go a long way to improving patient care and saving costs.
The brief, created by Health Affairs and the Robert Wood Johnson Foundation, makes note of the causes of poor care transitions and ways to improve these transitions. Among those causes and cures: communication.
Lack of communication between a hospital and the patient's regular outpatient provider is a major factor causing poor care transitions, notes the policy brief, and that can lead to costs.
Poorly-managed care transitions cost the U.S. healthcare system a great deal, noted Rachel Burton, the brief's author, who is a research associate at the Urban Institute, since, ultimately, they can lead to hospital readmissions.
"MedPAC estimates that the Medicare program spends $12 billion a year on potentially-preventable hospital readmissions. Among Medicare beneficiaries who are readmitted to the hospital within 30 days of a discharge, half will not have had any contact with a physician between their first hospitalization and their readmission - suggesting a lack of care transition management," said Burton.
"We actually know what activities providers can do to improve care transitions, reduce readmissions and save money - evidence from randomized controlled trials shows that specific care transitions interventions can cut hospital readmissions by a third," said Burton. "And it's pretty low-tech stuff - like calling patients to make sure they understand their discharge instructions."
HackensackUMC in New Jersey has taken steps towards improving care transitions through better communication by becoming one of four hospitals to pilot EmmiTransition, a program that engages users with interactive web-based programs. For instance, according to Devin Gross, CEO of Emmi Solutions, the program provides patients with important information before and after surgeries; sets up call-backs to patients who need medication refills and schedules follow-up appointments; and reports "red flags" to physicians.
According to Louis Teichholz, medical director of cardiac services at HackensackUMC, the hospital piloted the program along with three other hospitals with more than 100 discharged congestive heart failure (CHF) patients who received 45 days of consistent communication. Patients responded positively, healthcare staff saved an estimated 600 hours and staff received ongoing insight into patient status. More than 313 "red flags" - conditions that impact patient outcomes, satisfaction and risk - were reported that might have otherwise gone unidentified.
"In order to succeed with patients, you need the patient and family involved, and it's especially true with chronic conditions like heart failure," Teichholz. "The beauty of a program like this is that it makes multiple calls for you - even if it takes six calls to reach someone. With just our resources, this would be really hard."
Similarly, the emergency department at Riverside Health System in Virginia has been using Picis ED PulseCheck for several years to contact patients following discharges, and is able to identify patients in need of follow-up and automate the process for outreach and communication.
"We knew what we needed to do, but we had to make sure we were doing it consistently," said Renee Rountree, vice president of trauma and emergency services at Riverside. "Instead of only calling certain patients - the ones most at risk - we're able to contact every patient the following morning [after a patient's hospitalization in the emergency department], and we keep calling patients until we are able to make contact with them."
Teichholz added that many hospitals are interested in creating better communication methods at their organizations in order to reduce readmission rates.
"Now that the government is involved and hospitals are getting penalized for high readmission rates for certain conditions, we really would like to decrease our rates," he said.