Medicare Hospitalizations, Readmissions Drop in Transitions Project

Abstract

Hospitalizations and 30-day readmissions fell for Medicare patients in 14 communities when providers there worked with local quality improvement organizations (QIOs)to smooth and coordinate transitions between care settings, researchers from the Colorado Foundation for Medical Care and the Centers for Medicare & Medicaid Services reported in JAMA.The communities that participated in the 2-year CMS project saw mean reductions of 5.74% in hospitalizations and 5.70% in 30-day readmissions per 1,000 Medicare fee-for-service patients during 2009-2010. Fifty control communities saw smaller reductions: 3.17% in hospitalizations and 2.05% in readmissions (JAMA 2013;309:381-91).“Our results provide evidence of a … significant association between care transitions improvement interventions initiated by 14 [QIOs] and reductions in rehospitalizations and hospitalizations” as well as “evidence of a background national decline in hospitalizations and rehospitalizations for Medicare beneficiaries since 2008,” the researchers said.CMS left it up to each community to decide how best to improve transitions. QIOs guided the efforts and worked with local health care facilities and providers to improve a range of areas, including discharge standardization, medication reconciliation, chronic disease care planning, palliative care counseling, elder care services, and patient self-management. “Local community context was clearly relevant,” the investigators said.Each community used three or more evidence-based approaches such as Interventions to Reduce Acute Care Transfers, Re-Engineered Discharges, Transitional Care Nursing, the Care Transitions Program, and the Best Practices Intervention Packages on transitional care. The agency spent on average about $12 million annually to support the QIOs' efforts to coordinate improved care transitions.“Attempts to optimize care transitions will need to recognize that there is no single solution to address all the issues contributing to patient rehospitalization,” wrote Dr. Mark V. Williams, chief of the division of medicine–hospital medicine at the Northwestern University, Chicago, in an editorial (JAMA 2013;309:394-6). Hospitalizations and 30-day readmissions fell for Medicare patients in 14 communities when providers there worked with local quality improvement organizations (QIOs)to smooth and coordinate transitions between care settings, researchers from the Colorado Foundation for Medical Care and the Centers for Medicare & Medicaid Services reported in JAMA. The communities that participated in the 2-year CMS project saw mean reductions of 5.74% in hospitalizations and 5.70% in 30-day readmissions per 1,000 Medicare fee-for-service patients during 2009-2010. Fifty control communities saw smaller reductions: 3.17% in hospitalizations and 2.05% in readmissions (JAMA 2013;309:381-91). “Our results provide evidence of a … significant association between care transitions improvement interventions initiated by 14 [QIOs] and reductions in rehospitalizations and hospitalizations” as well as “evidence of a background national decline in hospitalizations and rehospitalizations for Medicare beneficiaries since 2008,” the researchers said. CMS left it up to each community to decide how best to improve transitions. QIOs guided the efforts and worked with local health care facilities and providers to improve a range of areas, including discharge standardization, medication reconciliation, chronic disease care planning, palliative care counseling, elder care services, and patient self-management. “Local community context was clearly relevant,” the investigators said. Each community used three or more evidence-based approaches such as Interventions to Reduce Acute Care Transfers, Re-Engineered Discharges, Transitional Care Nursing, the Care Transitions Program, and the Best Practices Intervention Packages on transitional care. The agency spent on average about $12 million annually to support the QIOs' efforts to coordinate improved care transitions. “Attempts to optimize care transitions will need to recognize that there is no single solution to address all the issues contributing to patient rehospitalization,” wrote Dr. Mark V. Williams, chief of the division of medicine–hospital medicine at the Northwestern University, Chicago, in an editorial (JAMA 2013;309:394-6).