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