M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP ... · M Krishnamoorthy MD, S...
Transcript of M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP ... · M Krishnamoorthy MD, S...
Readmission Risk Score: Reduce Healthcare Costs & Improve Patient Care
M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP, J Bolyard MD, FACP, A Chakka MD, FACP, J. Sutton MD, K Nelson PhD
Canton Medical Education Foundation, Department of Internal Medicine, Northeast Ohio Medical University
INTRODUCTION
Hospitals across the nation are being challenged to
reduce their readmission rates below the national
average of 18%.Our 476-bed teaching hospital
Internal Medicine service struggles with recurrent
readmissions and reimbursement.
AIM:
To reduce readmission rate of patients admitted
under the teaching service from the current rate of
13.5% to 10% in six months.
Process Overview: • Developasimplecost-effectivetooltoidentify patients at high risk for readmission specific to our population
• Applytooltoidentifyhigh-riskpatientsfor readmission and preventable readmission
• Effectivelyusehospitalresourcestointerveneon identified high-risk population
MEASURES:
Outcome: readmission rate of teaching service over
a period of six months.
Balance:
• Hospitallengthofstay
• Additionalphysicianeffortinidentifyinghigh-
risk population
PLAN:
Studypatientpopulationoversix-monthperiod
(01July2012to31Dec2012),readmittedatleast
twicein30-dayperiodtodevelopahospital-
specificscoringsystem
DO:
Applythescoringsystemoneverydischarge(N=54)
fromteachingserviceforonemonth(September2013)
STUDY:
Statisticalanalysistovalidatethescoringsystem
foridentifyingtheat-riskpatients.
• 54patientsdischargedin1month:
• Scoresforthe11patientsreadmittedwere
5.5±0.79(t=2.499;p=0.001)
• Scoresforthe43patientsnotreadmittedwere
3.0±0.31(t=2.499;p=0.001)
• Wecorrectlypredicted:
•59%ofthosereadmitted
•90%ofthosenotreadmitted
• Ouroverallpredictiveaccuracywas83.3%.
(t=2.499;p≤0.001).
CONCLUSIONS
WithfirstcycleofPDSA,wewereableto:
• Validateasimple,cost-effectivescoringsystem
foridentifyingreadmissions
• Effectivelypredictreadmissionriskinour
patient population
• Cluestopreventablefactors
• Actsasachecklisttopreventreadmissionatthe
time of discharge
Reduce Hospital
ReadmissionsPlan
Do
Study
Act
• Interventionstodecreasehospitalreadmissions:keysfor cost-effectiveness. BurkeRE1,ColemanEA.PMID:23529659
• RiskAssessmentTool:the8Ps BOOSTCareTransitionsResourceProjectTeam
• PotentiallyAvoidable30-DayHospitalReadmissionsin MedicalPatients:DerivationandValidationofa Prediction Model JacquesDonzé,MD,MSc;DrahomirAujesky,MD, JAMAInternMed.2013;173(8):632-638.
• Predicting30-dayall-causehospitalreadmissions.ShulanM1,GaoK,MooreCDPMID:23355120
FurtherPDSAcycleswillaimateffectivelyusing
limited hospital resources.
Interventionsmayinclude:
• Findingand/orschedulingfollow-upvisits
withPCP
• Promptlydictatingdischargesummaries
• Arranginghome-healthvisits
• Enrollingforprescriptionassistance
• Follow-upphonecallstoensurecompliance
NEXT STEPS:
REFERENCES
ACT:ApplyscoringsystemoneverydischargefromteachingserviceANDtoreinforcecompliance,residentswilldictatethescorewithassessment/plananddischargedictation.Nextsteps(listedsubsequently)willbetakentodecreasereadmissionsinourhighest-riskpatients.WealsoneedtoassessourbalancingmeasuresinsubsequentPDSAcycles.
DischargeScoringSystem Points
1)Numberofadmissionsinpast
6 months
2)Non-compliance(medication, 1
follow-upappointment)=1
3)Healthilliteracy(patient,caregiver’s 1
unawareness of diagnosis and
management)=1
4)Diagnosis(DM,COPD,CHF,PNA, 1
Cancer,CVA)=1
5)Pendingconsults/procedures=1 1
6)Secondarygain(drug/attention 1
seeking)=1
7) Improperdischargedisposition 1
(medicationreconciliation,placement)
8)Lackoftimelydischargefollow-up 1
appointment(CHF-1week,CAD-4weeks,
multipleco-morbidities-1to2weeks)
9)Lackofinsurance(MedicaidandMedicare) 1