Attacking a Major Health Issue: Hospital Readmissions

For those facing chronic disease, staying out of the hospital can be a big challenge.

It’s uncomfortable for patients and a significant cost within our health system.

Thankfully, several hospitals and health systems are finding creative solutions to address the issue.

This past weekend, the Associated Press reported on these efforts in a story that appeared in news outlets across the country.

A couple excerpts:

Hospital readmissions are miserable for patients, and a huge cost — more than $17 billion a year in avoidable Medicare bills alone — for a nation struggling with the price of health care.

Now, with Medicare fining facilities that don’t reduce readmissions enough, the nation is at a crossroads as hospitals begin to take action.

“Patients leave the hospital not necessarily when they’re well but when they’re on the road to recovery,” said Dr. David Goodman, who led a new study from the Dartmouth Atlas of Health Care that shows different parts of the country do a better job at keeping those people at home.

The Dartmouth study was commissioned by the Robert Wood Johnson Foundation, which then invited the AP as a partner to explore through focus groups it organized what happens at the hospital level that makes readmissions so difficult to solve.

In Portland, Ore., nurses at Oregon Health & Science University start teaching heart failure patients what they’ll need to do at home on their first day in the hospital, instead of just on their last day.

and

In heart failure, a weakly pumping heart allows fluid to build up until patients gasp for breath. Spotting subtle early signs like swelling ankles or creeping weight gain is crucial. But at the Oregon Health & Science University, nurse practitioner Jayne Mitchell spied as patients were told what to watch for as they were discharged — and they barely paid attention.

The new plan: Learn by doing.

Every morning, hospitalized patients weigh themselves in front of a nurse, record the result and get quizzed on what they’d do at home. Gained 2 pounds or more? Call the doctor for fast help. Lots of day-to-day fluctuation? A weekly log can help a doctor tell if a patient is getting worse or skipping medication or having trouble avoiding water-retaining salty food.

Step 2: These patients need a check-up a week after they go home. The hospital makes the appointment with a primary care doctor before they’re discharged, to ensure they can get one.

And for some high-risk patients who live too far away to easily track, Mitchell is pilot-testing whether a high-tech option helps them stick with care instructions.

During that first vulnerable month at home, those patients record their morning weight, blood pressure and heart rate on a monitor called the Health Buddy. It automatically sends the information back to Mitchell’s team at OHSU and also will flash instructions to the patient if it detects certain risks.

You can read the full story here.