A Mayo Clinic review of 47 studies found that 30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them. Key among these are interventions to help patients deal with the work passed on to them at discharge. The results of the review are published in this week's issue of JAMA Internal Medicine.
"Reducing early hospital readmissions is a policy priority aimed at improving quality of care and lowering costs," says Aaron Leppin, M.D., a research associate in Mayo Clinic's Knowledge and Evaluation Research Unit. "Most importantly, we need to address this issue because hospital readmissions have a big impact on our patients' lives."
To put this problem into context, studies estimate that 1 in 5 Medicare beneficiaries is readmitted within 30 days of a hospitalization, at a cost of more than $26 billion a year.
"Patients are sent home from hospitals because we have addressed their acute issues," says Dr. Leppin. "They go home with a list of tasks that include what they were doing prior to the hospitalization and new self-care tasks prescribed on discharge. Some patients cannot handle all these requests, and it is not uncommon for them to be readmitted soon after they get home. Sometimes these readmissions can be prevented."
After reviewing 47 randomized studies assessing methods to reduce readmissions, researchers identified that the most effective interventions—those that reduce readmissions by almost 40 percent—are more complex and are designed to help patients deal with the work of being a patient. These interventions were also found to save money for payers.
"Effective approaches often are multifaceted and proactively seek to understand the complete patient context, often including in-person visits to the patient's home after discharge," says Dr. Leppin. "This helps us assess the patients' living environment, their level of support, their resources, and their psychological and physical limitations."
The study also found that, over the last 20 years, there has been a tendency to get away from this approach and try simpler, more "high-tech" strategies; these have generally been less effective.