Quality collaboratives and campaigns to reduce readmissions: what strategies are hospitals using?
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ABSTRACT:
SUBMITTER: Bradley EH
PROVIDER: S-EPMC4029612 | biostudies-literature | 2013 Nov
REPOSITORIES: biostudies-literature
Publications
Quality collaboratives and campaigns to reduce readmissions: what strategies are hospitals using?
Bradley Elizabeth H EH Sipsma Heather H Curry Leslie L Mehrotra Devi D Horwitz Leora I LI Krumholz Harlan H
Journal of hospital medicine 20130906 11
<h4>Background</h4>Reducing hospital readmissions is a national priority, and many hospitals are participating in quality collaboratives or campaigns.<h4>Objective</h4>To describe and compare the current use of hospital strategies to reduce readmissions in 2 prominent quality initiatives-STAAR (State Action on Avoidable Rehospitalization) and H2H (Hospital-to-Home Campaign).<h4>Design</h4>Cross-sectional.<h4>Methods</h4>Web-based survey of hospitals that had enrolled in H2H or STAAR from May 200 ...[more]
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Project description:IntroductionPediatric hospital readmissions can represent gaps in care quality between discharge and follow-up, including social factors not typically addressed by hospitals. This study aimed to reduce the 30-day pediatric readmission rate on 2 general pediatric services through an intervention to enhance care spanning the hospital stay, discharge, and follow-up process.MethodsA multidisciplinary team developed an intervention bundle based on a needs assessment and evidence-based models of transitional care. The intervention included pre-discharge planning with a transition coordinator, screening and intervention for adverse social determinants of health (SDH), medication reconciliation after discharge, communication with the primary care provider, access to a hospital-based transition clinic, and access to a 24-hour direct telephone line staffed by hospital attending pediatricians. These were implemented sequentially from October 2013 to February 2017. The primary outcome was the readmission rate within 30 days of index discharge. The length of stay was a balancing measure.ResultsDuring the intervention, the included services discharged 4,853 children. The pre-implementation readmission rate of 10.3% declined to 7.4% and remained stable during a 4-month post-intervention observation period. Among 1,394 families screened for adverse SDH, 48% reported and received assistance with ≥ 1 concern. The length of stay increased from 4.10 days in 2013 to 4.30 days in 2017.ConclusionsAn intervention bundle, including SDH, was associated with a sustained reduction in readmission rates to 2 general pediatric services. Transitional care that addresses multiple domains of family need during a child's health crisis can help reduce pediatric readmissions.
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