Caught in hospital hell s revolving door: Too many early readmissions

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Research shows that poor coordination among providers all-too-often leads to patients returning to the hospital within 30 days of being discharged. Readmissions following hospitalizations for heart failure, acute MI (heart attack), and pneumonia are common among Medicare beneficiaries, researchers reported in JAMA .

Harlan Krumholz, MD, of the Yale University School of Medicine, and colleagues examined readmissions following hospitalizations for heart failure, acute MI, and pneumonia by examining Medicare fee-for-service claims data from 2007 to 2009. The study included readmissions following 1,330,157 hospitalizations for heart failure, 548,834 for acute MI, and 1,168,624 for pneumonia. The 30-day readmission rates were 24.8 percent, 19.9 percent, and 18.3 percent, respectively, with readmission occurring most frequently within the first 15 days after discharge.

They noted that interventions targeting a variety of conditions or those involving a multidisciplinary team have been shown to be more effective in reducing readmissions than more specific interventions.

"Efforts moving forward should involve implementation of broad patient-centered approaches that engage all members of a care team, especially front-line clinicians, and use proven quality-improvement methods such as statistical process control to identify helpful interventions," Mark Williams, MD, of Northwestern University Feinberg School of Medicine, wrote in an accompanying editorial.

Specialists and subspecialists leave the patients confused. A quarterback physician is needed to coordinate care, says ACSH s Dr. Gilbert Ross. Too much fragmentation, or silo-care, in which each specialist focuses on their one area without reviewing the patient s totality of care, accounts for much of this problem.