Posted by:
JudyAnn Bigby, MD, Secretary of Health and Human Services
One of the top priorities for the Patrick-Murray Administration and the Executive Office of Health and Human Services is to find ways to deliver quality care to individuals and contain the rising costs of health care in the Commonwealth. A key avenue for reducing costs is to lower the rate of hospital readmissions throughout the state by improving the coordination of care people receive across hospital and other settings by multiple providers. Every year (since 2005), the state’s Betsy Lehman Center for Patient Safety and Medical Error Reduction honors a healthcare provider, health organization, or individual for their leadership and innovation in patient safety with the Betsy Lehman Patient Safety Recognition Award. The theme for the 2010 Betsy Lehman Award highlighted the importance of issues related to patient care transitions. A six member Lehman Center Award Review Committee used a set of criteria to evaluate nominees on how well they could demonstrate that their efforts to make improvements had resulted in safer and more effective care transitions for patients across the healthcare continuum. This year’s award recipient, MetroWest Medical Center/Vanguard Health Systems (MWMC), successfully implemented interventions that resulted in lowering the rate of readmissions for certain patients with congestive heart failure. MWMC has been a participant in the multi-state, multi-stakeholder State Action on Avoidable Re-hospitalizations initiative known as STAAR.
In Massachusetts, more than 10 percent of patients return to the hospital within a month of discharge, and over a two-year period more than a quarter of all patients end up with a repeat visit to the hospital. According to a 2007 Congressional report by the Medicare Payment Advisory Commission, three-quarters of hospital readmissions could be avoided with increased efforts designed to prevent unnecessary rehospitalizations. Massachusetts ranks 37th in the nation on the rate of 30-day readmissions among Medicare beneficiaries, with a rate of 19%. If Massachusetts improved to the same percent of readmissions as the best performing state in the nation, 13%, this would mean $96 million in savings.
As patients travel from one care setting to another, there is always potential for break-downs in communication along the way; poor coordination of care among providers can leave patients, especially those with complex and chronic health care conditions, particularly vulnerable to the occurrence of adverse medical events. Such events can be avoided with more comprehensive discharge practices designed to prevent communication break-down during care transitions.
MWMC introduced multiple strategies for improving communications, including visiting patients more frequently during the initial weeks of their return to homecare and providing standardized teaching materials and discharge materials to patients and their families. These practices, known as 'front loading,' provide more care to patients when they are sickest, allowing clinicians to observe them more closely during this critical time of recuperation.
MWMC serves as a shining example of the importance of communication between providers and patients and the utility of patient education. In the 11 months following the launch of its participation in the STAAR initiative, MWMC achieved an exceptional level of success: a 50 percent reduction in heart-failure readmissions. MWMC’s coordinated efforts to follow-up with heart-failure patients and ensure direct communication between patients and their doctors is truly exemplary and illustrates how reducing unnecessary hospital readmissions can play a critical role in improving overall care throughout the Commonwealth.
For more information about hospital readmissions: http://www.boston.com/news/health/articles/2010/06/21/seeking_ways_to_reduce_hospital_readmissions__to_cut_costs_while_improving_care/
This just happened to our very healthy 87-year-old mother who was hospitalized at a world famous Boston hospital with an infection in her toe and then contracted a staph infection at the hospital. She was treated and released, still on antibiotic to treat the staph infection, to a rehab only to return within a week to the same hospital with a C-Diff infection from the staph antibiotic resulting in a toxic megacolon and followed by a total colectomy. She developed an arrythmia as a result of surgery. Again she was discharged with a heart rate of 120 and very high blood pressure to a rehab and within one hour of discharge was admitted to a local hospital and diagnosed with mild congestive heart failure.
The local hospital has treated her like a human being and she has received proper care and not rushed out the door. Not only has the experience been harrowing for her and our family but definitely has not been cost effective for insurance/medicare. We cannot understand how if a hospital 'knows' that staph antibiotics can cause C-Diff, why the proper precautions and preventions were not followed to allow this dreadful bacteria to cause such damage, especially when our mother was symptomatic for C-Diff during her treatment for the staph infection while she was still in the Boston hospital.
Something needs to be done to prevent families from going through such an ordeal when it seems that a little time taken in the beginning can save a lot of anguish, suffering, and would be far more cost effective. We have well-documented information on this experience as we posted daily, sometimes hourly, on a family website as to what was occurring at the time it was occurring. Total time that transpired has been 6 weeks plus and counting.
With the thorough care our mother has received at the local hospital, we are hopeful that she will recover. This good woman should not have had to endure all she has gone through because of insurance or a need to rush her out and on her way.
Feel free to contact us if you are interested in reviewing this case and her medical records.
Posted by: Joan Scribner | March 28, 2011 at 12:10 PM