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Author: Laura Lowe
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 0
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Book Description
The information gathered through post-hospital discharge calls can serve as a catalyst for systematic changes in how care is delivered and communicated. Nearly 1 out of 8 patients discharged from a hospital report new or worse symptoms within 2-3 days after going home. Yet despite feeling worse, these patients are only minimally more likely to make follow-up appointments to address their new healthcare concerns. Readmission reduction is largely a new frontier, launched by changes in heathcare reimbursement incentives. Healthcare organizations are looking for sensible, targeted, and measureable approaches to manage the problem of readmissions. Readmissions are a demonstratable problem. Nearly 1 in every 5 Medicare patients admitted to a hospital in a year is readmitted within 30 days. By 90 days, the rate increases to 1 in 3. The cost to Medicare of these readmissions alone was $18 billion in 2007. Health promotion and illness prevention are integral components of the newest approaches to healthcare delivery. Many readmissions are related to medication safety events and readmissions are costly to patients and 3rd party payers. With reimbursement now being tied to patient outcomes, reducing readmissions will be significant to this organization's net operating income. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was used for this project process. Dorothea E Orem's Self-Care Deficit Nursing Theory offers the explanation that both internal and external conditions arising from or associated with health states of individuals can bring about action limitation of individuals to engage in care of self. Readmissions from pre-implementation of discharge follow-up phone calls were compared to post implementation of the calls. For the intermediate outcome, there would be a desired downward trend of readmissions. Post-visit phone calls improve clinical outcomes, increase patient satisfaction, and decrease costly and unnecessary return visits to the emergency department as well as readmissions to hospitals.
Author: Laura Lowe
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 0
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Book Description
The information gathered through post-hospital discharge calls can serve as a catalyst for systematic changes in how care is delivered and communicated. Nearly 1 out of 8 patients discharged from a hospital report new or worse symptoms within 2-3 days after going home. Yet despite feeling worse, these patients are only minimally more likely to make follow-up appointments to address their new healthcare concerns. Readmission reduction is largely a new frontier, launched by changes in heathcare reimbursement incentives. Healthcare organizations are looking for sensible, targeted, and measureable approaches to manage the problem of readmissions. Readmissions are a demonstratable problem. Nearly 1 in every 5 Medicare patients admitted to a hospital in a year is readmitted within 30 days. By 90 days, the rate increases to 1 in 3. The cost to Medicare of these readmissions alone was $18 billion in 2007. Health promotion and illness prevention are integral components of the newest approaches to healthcare delivery. Many readmissions are related to medication safety events and readmissions are costly to patients and 3rd party payers. With reimbursement now being tied to patient outcomes, reducing readmissions will be significant to this organization's net operating income. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was used for this project process. Dorothea E Orem's Self-Care Deficit Nursing Theory offers the explanation that both internal and external conditions arising from or associated with health states of individuals can bring about action limitation of individuals to engage in care of self. Readmissions from pre-implementation of discharge follow-up phone calls were compared to post implementation of the calls. For the intermediate outcome, there would be a desired downward trend of readmissions. Post-visit phone calls improve clinical outcomes, increase patient satisfaction, and decrease costly and unnecessary return visits to the emergency department as well as readmissions to hospitals.
Author: Jordan Ray Rentmeister
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
The U.S. Centers for Medicare and Medicaid Services (CMS) spends nearly 17-26 billion dollars a year on hospital readmissions. This is due to nearly 1/5 of all patients being re-admitted to the hospital within 30 days of being discharged. 15 to 20 billion dollars are spent on unplanned readmission in the average year. If avoidable readmissions are able to be prevented there is a high potential of improving the patient's quality of life and health care systems finance. The ARCC model was used, this along with RED toolbox helped to assure the implementation and effectiveness of this project. The ARCC model is based on EBP mentorship, meaning that during the implementation of this project there was someone that truly knows the problem and has looked into the research on how to fix the problem. The ARCC model accompanied by the transition theory work hand and hand for the implementation of this scholarly project. Transition theory-based discharge planning can guide health profession interventions to standardized care. Combining care at home with hospital care strengthens ongoing patient management. Not only were patients helped by limiting post-operative readmissions the hospital saved potentially millions of dollars per year, as well as staff member's time and energy. This was done by being proactive and preventing and preventing issues before they can arise or become serious. Based on the literature there was anywhere from a 20-30% decrease in hospital readmissions using the template provided through the RED toolkit, the desire was to decrease the readmission rates during the project somewhere in this range. For the risk/barriers of this project the focus was on potential costs implemented on the hospital. Another issue was finding the staff or the time for these phone calls to be implemented. For this project the staff members making the phone calls were the phase 2 recovery staff. These staff members were already at the hospital, being paid while waiting for their next patient being discharged from the recovery department. Utilizing staff time by making these phone calls in between patients costs the hospital no money, addresses concerns and questions from patients, lowers hospital readmission rates, and increases hospital satisfaction scores. In conclusion 387 phone calls were attempted in the month of November, of the 387 phone calls attempted 68 patients were not contacted. There were 846 patients that had surgery during the month of November at Davis Hospital and medical Center. Of the 319 out of the 846 patients that were actually contacted only one patient returned for surgery during the month of November. The McNemar's test showed a statistical difference between the pre and post intervention group, proving the null hypothesis false.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309133939
Category : Medical
Languages : en
Pages : 374
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Book Description
As our nation enters a new era of medical science that offers the real prospect of personalized health care, we will be confronted by an increasingly complex array of health care options and decisions. The Learning Healthcare System considers how health care is structured to develop and to apply evidence-from health profession training and infrastructure development to advances in research methodology, patient engagement, payment schemes, and measurement-and highlights opportunities for the creation of a sustainable learning health care system that gets the right care to people when they need it and then captures the results for improvement. This book will be of primary interest to hospital and insurance industry administrators, health care providers, those who train and educate health workers, researchers, and policymakers. The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in health care decision making. The Roundtable on Evidence-Based Medicine serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care.
Author:
Publisher:
ISBN:
Category : Community health aides
Languages : en
Pages : 20
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Author: Barbara Worgan
Publisher:
ISBN:
Category : Aortic valve
Languages : en
Pages : 37
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Book Description
Abstract Follow-up Telephone Call Quality Initiative: Do Follow-up Telephone Calls After Discharge Reduce 30-day Hospital Readmission For Transcatheter Aortic Valve Replacement Recipients? Barbara Worgan, MSN, ANP Background: Outcomes of nursing interventions following discharge for recipients of transcatheter aortic valve replacement (TAVR) are scarce. Purpose: This quality improvement project was a retrospective cohort design to evaluate the effectiveness of a follow-up telephone call on reducing 30-day hospital readmission for patients recovering from the TAVR procedure. Methods and Results: A convenience sample of 50 patients was used, 25 who received the follow up phone calls and 25 who did not. Twenty-five patients were selected from those TAVR patients who did received a follow-up telephone call between January 20 - May 20, 2017 and 25 TAVR patients from those who were not exposed to the intervention between January 20 - May 20, 2016. The cohorts were matched based on sex and NYHA CHF classification at time of the hospital admission. Both hospital length of stay and postoperative length of stay were shorter in the intervention group than the control group. Patients who received the follow-up telephone call post discharge spent on average 2.20 days less in the hospital than those who did not receive the follow up telephone call, 3.92 ± 1.9 days vs 6.12 ± 3.95 days respectively, t = 2.53 (34), p = 0.01. Patients who received the follow-up telephone call post-discharge spent on average 1.28 days less in the hospital after their procedure than those who did not receive the follow-up telephone call, 2.84 ± 1.7 days vs 4.12 ± 2.57 days respectively, t = 2.07 (48), p = 0.01. However, there was no significant difference in readmissions within 30 days of discharge in those received the follow-up phone call post-discharge (n=4, 8%) and those who did not receive the follow-up phone call post-discharge (n=4, 8%). Conclusions: The quality improvement follow-up telephone call initiative did not reduce the rate of hospital readmission. Although, this program did not evaluate patient reported outcomes, future projects should not only consider hospital readmissions but other quality measures as well.
Author: Kerm Henriksen
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 526
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Book Description
v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.
Author: Garrett Reichle
Publisher:
ISBN: 9780355598100
Category : Electronic dissertations
Languages : en
Pages : 115
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Author:
Publisher:
ISBN:
Category :
Languages : en
Pages : 17
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Objective: To evaluate the effectiveness of a post-discharge telephone follow-up process that assesses the recovery status of patients recently discharged from the hospital or evaluated in the ER and transfers care from the hospital to the primary care provider. Study Design: This study is an impact evaluation comparing patterns in primary care provider follow-up time, patient satisfaction and clinician satisfaction from three months prior to implementation to three months after implementation of a standardized post-discharge follow-up protocol. The protocol was implemented within four direct practice primary care clinics throughout the greater Seattle area. The primary participants in this study were a convenience sample of patients who had visited an ER or been hospitalized during the test period. The intervention was a follow-up telephone call, performed by an RN or medical assistant, made to patients recently discharged from a hospital or ER. Methods: Quantitative measures of follow-up care included the number of elapsed days between the patient's hospital discharge and follow-up with the primary care provider between the pre- and post-evaluation phases, the number of repeat emergency room visits, number of hospital readmissions. Patient satisfaction data were collected via surveys to quantitatively measure overall satisfaction with the follow-up care they received from their primary care provider following a hospitalization or ER visit. Clinician satisfaction data were collected from semi-structured group interviews with clinicians regarding hospital follow-up processes before and after implementation of the standardized protocol. Results: No significant change in overall mean and median PCP follow-up time was detected but the variation in follow-up time (in days) decreased in the post-protocol implementation period. During the pre-protocol period, the mean time to follow up with patients after discharge from the ER or hospital was 5.41 days and post-protocol showed a slight decrease to 4.76 days. Median follow-up time remained steady at 3 days between both testing periods. The post-protocol period also showed an increase in hospital readmissions from 4 to 8 and a decrease in repeat ER visits from 9 to 5 since the pre-protocol period. Patient satisfaction appeared to increase between the pre- and post-test periods but due to a low survey response rate, further research is needed to confirm the reliability of these data.
Author: Diahann K Wilcox
Publisher:
ISBN:
Category : Electronic dissertations
Languages : en
Pages :
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Book Description
Reducing hospital readmissions has become a national priority to improve the quality of care and lower health care spending. Section 3026 of the Affordable Care Act of 2010 created the Community-based Care Transition Program (CCTP) to reduce 30-day all-cause readmissions in the Medicare FFS population. A CCTP program called the Community Passport 2 Care (ComPass2c) was implemented in nine hospitals in New England. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) was used to evaluate the ComPass2c program in reducing 30-day readmissions in Medicare FFS beneficiaries discharged from one academic hospital in New England. A retrospective analysis of the ComPass2c program was performed. Eight hundred thirty-two subjects enrolled in the ComPass2c program; 61% were female with a mean age of 79 years (SD = 13). Using linear regression, the unadjusted 30-day all-cause readmission rate decreased by 0.5% each quarter (p = .03) for the first eight quarters of the ComPass2c program with a relative risk reduction of 23%. The ComPass2c program reached 32% of eligible Medicare FFS beneficiaries at Hospital X. Implementation for post-discharge phone calls was 89% and 34% for post-discharge home visits. The mean change in patient activation scores was 0.15 (SD = 4.79) without a significant change in activation level (χ2 (6) = 3.819, p = .70). The data support the conclusion that the ComPass2c program may have been effective in reducing 30-day all-cause readmission rates in Medicare FFS beneficiaries discharged from an academic hospital in New England. The program reached one third of the target Medicare FFS population. The implementation of post-discharge phone calls was similar to the original research but low for home visit and without change in patient activation. The Doctor of Nursing Practice (DNP) is in a unique leadership position to assess and determine the need for systems change at all levels of care, implement and evaluate evidence-based interventions in clinical practice, and facilitate interprofessional collaboration to improve quality of care. Future research should test transitional care interventions in subjects at risk for readmission who have historically been excluded, difficult to enroll and activate, and in receive care at safety net hospitals.
Author: Lualhati Espina Dursun
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Abstract Problem 0́3 The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission. Context 0́3 Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates. Interventions 0́3 Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates. Measures & Results 0́3 Identified high-risk patients that need timely follow-up appointment before hospital discharge. Through chart audits and call logs (from HUB Staff), 75% identified high-risk patients would have a scheduled follow-up appointment before hospital discharge. Conclusions 0́3 Probable conclusions that can happen from this change in process project may be that there are external issues that prevent this change from happening. Discharged patients from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.
