Six strategies for reducing hospital readmissions among elderly

One in five Americans on Medicare winds up back in the hospital within 30 days of discharge, but a new Yale-led study suggests that there are ways to prevent this from happening for many of those patients, particularly those suffering from heart failure. The study appears in the July issue of Circulation: Cardiovascular Quality and Outcomes.

Hospital readmissions for older patients cost American taxpayers more than $15 billion per year. But the researchers found only 30 percent of hospitals they surveyed were taking measures to prevent these readmissions and reduce the economic burden.

The team surveyed nearly 600 hospitals and identified six strategies for reducing hospital readmissions:

  • partnering with community physicians;
  • partnering with local hospitals;
  • assigning responsibility for medication reconciliation to nurses;
  • sending patients home from the hospital with an outpatient follow-up appointment already made;
  • having a process in place to send all discharge or electronic summaries directly to the patient’s primary care physician;
  • assigning staff to follow up on test results after the patient is discharged.

Further, researchers found that the reduction in readmissions was greater when more of these strategies were implemented.

Led by Elizabeth Bradley, faculty director of the Yale Global Health Leadership Institute, the study focused on patients with heart failure due to the higher readmission rates among this group. “Given the prevalence of heart failure, even modest effects could improve transitions for more than 850,000 patients per year,” said Bradley. “It was surprising that only 7 percent of hospitals were implementing all six of the strategies, even though reducing readmissions is a national priority.”

Bradley explained that even though the strategies seem relatively inexpensive, they require greater collaboration and communication beyond the walls of the hospital, and that while hospitals are investing resources to improve patient care, they may not be investing in all the right areas.

Other authors on the study include Leslie Curry, Leora Horwitz, Heather Sipsma, Yongfei Wang, Mary Norine Walsh, Don Goldmann, Neil White, Ileana Pina, and Harlan M. Krumholz.

This work was supported by the Commonwealth Fund; the Center for Cardiovascular Outcomes Research at Yale University; the National Heart, Lung, and Blood Institute (U01HL105270-03); the National Institute on Aging (K08 AG038336); the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program; the Claude D. Pepper Older Americans Independence
 Center at Yale School of Medicine; the National Institute on Aging ((#P30AG021342); and an AQ11 research grant from Medtronic through Yale University.  This work was also partially funded by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health.

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