M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP ... · M Krishnamoorthy MD, S...
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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: • Develop a simple cost-effective tool to identify patients at high risk for readmission specific to our population • Apply tool to identify high-risk patients for readmission and preventable readmission • Effectively use hospital resources to intervene on identified high-risk population MEASURES: Outcome: readmission rate of teaching service over a period of six months. Balance: • Hospital length of stay • Additional physician effort in identifying high- risk population PLAN: Study patient population over six- month period (01July2012 to 31Dec2012), readmitted at least twice in 30-day period to develop a hospital- specific scoring system DO: Apply the scoring system on every discharge (N=54) from teaching service for one month (September 2013) STUDY: Statistical analysis to validate the scoring system for identifying the at-risk patients. • 54 patients discharged in 1 month: • Scores for the 11 patients readmitted were 5.5 ± 0.79(t= 2.499; p = 0.001) • Scores for the 43 patients not readmitted were 3.0 ± 0.31 (t= 2.499; p = 0.001) • We correctly predicted : • 59% of those readmitted • 90% of those not readmitted • Our overall predictive accuracy was 83.3 %. (t= 2.499; p ≤ 0.001). CONCLUSIONS With first cycle of PDSA, we were able to: • Validate a simple, cost-effective scoring system for identifying readmissions • Effectively predict readmission risk in our patient population • Clues to preventable factors • Acts as a checklist to prevent readmission at the time of discharge Reduce Hospital Readmissions Plan Do Study Act • Interventions to decrease hospital readmissions: keys for cost-effectiveness. Burke RE1, Coleman EA.PMID:23529659 • Risk AssessmentTool: the 8Ps BOOST CareTransitions Resource ProjectTeam • Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients: Derivation and Validation of a Prediction Model Jacques Donzé, MD, MSc; Drahomir Aujesky, MD, JAMA Intern Med. 2013;173(8):632-638. • Predicting 30-day all-cause hospital readmissions. Shulan M1, Gao K, Moore CD PMID: 23355120 Further PDSA cycles will aim at effectively using limited hospital resources. Interventions may include: • Finding and/or scheduling follow-up visits with PCP • Promptly dictating discharge summaries • Arranging home-health visits • Enrolling for prescription assistance • Follow-up phone calls to ensure compliance NEXT STEPS: REFERENCES ACT: Apply scoring system on every discharge from teaching service AND to reinforce compliance, residents will dictate the score with assessment /plan and discharge dictation. Next steps (listed subsequently) will be taken to decrease readmissions in our highest-risk patients. We also need to assess our balancing measures in subsequent PDSA cycles. Discharge Scoring System Points 1) Number of admissions in past 6 months 2) Non-compliance (medication, 1 follow-up appointment) = 1 3) Health illiteracy (patient, caregiver’s 1 unawareness of diagnosis and management) = 1 4) Diagnosis (DM, COPD, CHF, PNA, 1 Cancer, CVA) = 1 5) Pending consults/procedures = 1 1 6) Secondary gain (drug/attention 1 seeking) = 1 7) Improper discharge disposition 1 (medication reconciliation, placement) 8) Lack of timely discharge follow-up 1 appointment (CHF-1week, CAD-4 weeks, multiple co-morbidities - 1 to 2 weeks) 9) Lack of insurance (Medicaid and Medicare) 1
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
