Featured Research

from universities, journals, and other organizations

Reducing avoidable rehospitalizations among seniors: Unique approach improves discharge disposition and patient outcomes

Date:
June 13, 2011
Source:
Hebrew SeniorLife Institute for Aging Research
Summary:
A new study demonstrates improvements in discharge disposition following a three-pronged intervention that combines standardized admission templates, palliative care consultations, and root-cause-analysis conferences.

The rehospitalization of senior patients within 30 days of discharge from a skilled nursing facility (SNF) has risen dramatically in recent years, at an estimated annual cost of more than $17 billion. A new study from Hebrew Rehabilitation Center (HRC), an affiliate of Harvard Medical School, demonstrates improvements in discharge disposition following a three-pronged intervention that combines standardized admission templates, palliative care consultations, and root-cause-analysis conferences.

Related Articles


The study, published in the June issue of the Journal of the American Geriatrics Society, compared patients' discharge disposition from HRC's Recuperative Services Unit (RSU) in Boston, a skilled nursing facility, before and after implementation of the intervention. The rate of patient rehospitalization fell from 16.5 percent to 13.3 percent, a drop of nearly 20 percent. Discharges to home increased from 68.6 percent to 73.0 percent, and discharges to long-term care dropped to 11.5 percent from 13.8 percent.

"The change in discharge disposition observed between the two periods, we believe, reflects an improvement in patient outcomes," says lead author Randi E. Berkowitz, M.D., a geriatrician at Hebrew Rehabilitation Center and medical director of the RSU. "Specifically, a lower acute transfer rate likely reflects improved processes of care in the SNF."

One out of five Medicare beneficiaries was rehospitalized within 30 days of hospital discharge, costing an estimated $17.4 billion, according to recent estimates. In addition, hospitalized patients admitted to a skilled nursing facility have a high rate of early, unplanned rehospitalization. There are many risk factors that correlate with future hospitalization, says Dr. Berkowitz, such as recent hospitalization, specific diagnoses (such as congestive heart failure), acute medical illnesses, depression, and other factors.

From the older patient's perspective, hospital readmission can lead to a steady decline in functional status, ending in disability. As a result, these seniors must often trade their independent living for a long-term care facility.

As part of national health-care reform legislation, Medicare will stop paying hospitals for preventable readmissions for conditions such as heart failure and pneumonia, beginning in October 2012. Two years later, the list will expand to include additional medical conditions.

"Reducing rehospitalization has become a national target of health-care reform," says Robert J. Schreiber, M.D., HSL's chief medical officer. "Readmissions have a significant impact on the nation's health system and are often preventable."

Developed by HSL's Department of Medicine and key nursing, administrative and social service leaders, the admission template includes care guidelines for common geriatric syndromes, medication reconciliation, and goals of care, as well as a question about how many times the patient had been hospitalized over the past six months. A section on advance directives asks whether the patient or health-care proxy would want subsequent hospitalizations if the patient's condition deteriorated while on the SNF.

HRC's palliative care team consulted with patients who had three or more hospitalizations in the past six months to determine whether rehospitalization was consistent with the patient's goals of care, or if worsening symptoms would be managed best on a SNF, in long-term care, or at home.

Team Improvement for the Patient and Safety (TIPS) conferences were held bimonthly to examine the root causes of rehospitalizations. Selected cases of preventable rehospitalizations were reviewed to identify ways in which the team could have operated more effectively. Depending on the specific causes identified, further information would be sought and additional staff or outside experts would be invited to participate in subsequent TIPS sessions.

"We designed the intervention to promote the importance of patients' goals of care and to help staff see transitions of care as an important part of their work product," says Dr. Berkowitz, an instructor in medicine at Harvard Medical School.


Story Source:

The above story is based on materials provided by Hebrew SeniorLife Institute for Aging Research. Note: Materials may be edited for content and length.


Journal Reference:

  1. Randi E. Berkowitz, Richard N. Jones, Ron Rieder, Margaret Bryan, Robert Schreiber, Sharon Verney, Michael K. Paasche-Orlow. Improving Disposition Outcomes for Patients in a Geriatric Skilled Nursing Facility. Journal of the American Geriatrics Society, 2011; DOI: 10.1111/j.1532-5415.2011.03417.x

Cite This Page:

Hebrew SeniorLife Institute for Aging Research. "Reducing avoidable rehospitalizations among seniors: Unique approach improves discharge disposition and patient outcomes." ScienceDaily. ScienceDaily, 13 June 2011. <www.sciencedaily.com/releases/2011/06/110613014457.htm>.
Hebrew SeniorLife Institute for Aging Research. (2011, June 13). Reducing avoidable rehospitalizations among seniors: Unique approach improves discharge disposition and patient outcomes. ScienceDaily. Retrieved November 24, 2014 from www.sciencedaily.com/releases/2011/06/110613014457.htm
Hebrew SeniorLife Institute for Aging Research. "Reducing avoidable rehospitalizations among seniors: Unique approach improves discharge disposition and patient outcomes." ScienceDaily. www.sciencedaily.com/releases/2011/06/110613014457.htm (accessed November 24, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Monday, November 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

AFP (Nov. 23, 2014) The arable district of Kenema in Sierra Leone -- at the centre of the Ebola outbreak in May -- has been under quarantine for three months as the cocoa harvest comes in. Duration: 01:32 Video provided by AFP
Powered by NewsLook.com
Don't Fall For Flu Shot Myths

Don't Fall For Flu Shot Myths

Newsy (Nov. 23, 2014) Misconceptions abound when it comes to your annual flu shot. Medical experts say most people older than 6 months should get the shot. Video provided by Newsy
Powered by NewsLook.com
WFP: Ebola Risks Heightened Among Women Throughout Africa

WFP: Ebola Risks Heightened Among Women Throughout Africa

AFP (Nov. 21, 2014) Having children has always been a frightening prospect in Sierra Leone, the world's most dangerous place to give birth, but Ebola has presented an alarming new threat for expectant mothers. Duration: 00:37 Video provided by AFP
Powered by NewsLook.com
Could Your Genes Be The Reason You're Single?

Could Your Genes Be The Reason You're Single?

Newsy (Nov. 21, 2014) Researchers in Beijing discovered a gene called 5-HTA1, and carriers are reportedly 20 percent more likely to be single. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins