A study published this week in the Journal of the American Medical Association shows that having Quality Improvement Organizations (QIOs) to improve care transitions decreased hospitalizations and re-hospitalizations of Medicare beneficiaries by nearly 6 percent over two years.
The decline in re-hospitalization rates among the 14 QIOs studied were nearly double the declines shown in communities where there was organized effort to improve care transitions for Medicare beneficiaries upon discharge from hospitals.
The QIOs, which have been funded under a Centers for Medicare & Medicaid Services pilot program, systematically coordinated community-based efforts with hospitals and other organizations and care providers to improve transitions in care, with the ultimate goal of reducing unnecessary hospital re-admissions.
While readmission rates declined by an average of 5.7 percent among the 14 communities with QIOs, the study also showed the unexpected result that hospitalizations among Medicare beneficiaries in these communities also declined by an average of 5.74 percent.
"Millions of older patients across the nation know what happens when their healthcare is not well coordinated – they end up back in the hospital," said Mary Ellen Dalton, president of the American Health Quality Association (AHQA), during a press briefing Wednesday on the study. AHQA is the national association representing QIOs that are working to improve the quality of healthcare in communities. "Hospital readmissions are not just a hospital problem, or a patient problem. They are a community problem, and ensuring that all sectors of a community work together to make care transitions effective is vitally important."
The methods used by the QIOs in the program were significantly different than those typically used by hospitals, which have tended to focus on specific disease or hospital department programs and interventions.
"One of the key things we think is so important about this is the demonstration that convening a bunch of providers – and not just medical service providers – to really address the entire continuum of care that elderly people need at the time they are discharged form the hospital can be effective and effective fairly quickly," said Jane Brock, MD, during the press briefing. Brock is the lead author of the report and chief medical officer of the Colorado Foundation for Medical Care in Englewood, Colo., one of the QIOs studied.
"When you have a bunch of providers working in concert on behalf of the population they already mutually serve, we think that is the key intervention that explains our success," Brock added.
Results of the work done by the QIOs showed that the quality improvements were associated with roughly 6,800 hospitalizations and 1,800 re-hospitalizations averted per year. Extrapolating the results showed that among a community of 50,000 fee-for-service Medicare beneficiaries, the care improvements would have resulted in savings of $4 million per year in hospitalization costs, while incurring a program cost of only $1 million.
Within the program the QIOs continually reviewed progress and tailored activities to implement interventions that were effective and met the needs of each community. While tailored to each community, the successful strategies adopted by the QIOs in the 14 communities generally fell into one of the following categories:
- Developing effective community coalitions involving hospitals, nursing facilities, home care, hospice agencies, physicians and local agencies to help meet social service needs that may prevent patients from getting or staying well.
- Generating and implementing standard transition processes across all local healthcare settings.
- Transferring patient clinical information between providers in a timely and effective way.
- Helping patients and their family members become actively engaged in their transitions by keeping a personal record, knowing the 'red flags' for trouble, ensuring they receive the right medications and follow-through on appropriate follow-up care.
The 14 communities involved in the project were in Tuscaloosa, Ala., Denver, Miami, Atlanta, Evansville, Ind., Baton Rouge, La., Lansing, Mich., Omaha, Neb., Camden, N.J., Albany, N.Y., Pittsburgh, Providence, R.I., Harlingen, Texas, and Whatcom County, Wash.