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 New Studies Find Links Between Quality Of Care And Hospital Readmissions

A new study suggests a connection between a skilled nursing care center’s readmission rate and quality of care. Lead author Momtazur Rahman, MD, and his team analyzed four years (2009-2013) of Medicare data on skilled nursing center admissions and hospital readmissions. They found that a historically high readmission rate reliably predicts future readmissions.

“We think that quality is reflected in the readmission rate, although we don’t know about the impact of things such as communication between settings and how transitions are handled,” says Rahman.

The problem with readmission rates, Rahman admits, is that they don’t tell the whole story about the patient's condition. There is no real way to determine if facilities had higher readmission rates because they received sicker patients.
However, Rahman observes that, according to their research, if a patient is admitted to a nursing center that has a 25 percent historical readmission rate as opposed to one with a 15 percent rate, the chance of being readmitted to the hospital increases by 8 percent. Their findings, he suggests, make it difficult to support the idea that a nursing center’s readmission rate depends on differences in patient conditions and not on the quality of care.
In truth, Rahman says, “Patients and families, as well as hospitals, will be looking at readmission rates as one element when they are choosing a nursing home. So facilities will need to figure out how to reduce readmissions moving forward.” The study appeared in an online version Oct. 21, 2016, prior to inclusion in the journal, Health Services Research.
A study published in JAMDA earlier this year supported the idea that better coordination between hospitals and post-acute care facilities could reduce readmissions and mortality rates. The study identified several risk factors that contribute to readmission. These include the patient’s need for an invasive device, such as a feeding tube or urinary catheter, and the patient’s need for advanced care, such as dialysis and oxygen therapy. 
Improved care transitions are widely considered essential to reduced readmissions. Key components of this include accurate patient records and medication regimens moving between settings and clear and effective avenues of communication.
Additionally, nursing centers must prepare patients on discharge to function successfully at home. Increasingly, this involves home visits by social workers, physical therapists, or others to assess environmental safety and the patient’s support systems, clinical experts say. Physician follow-up and consultations with pharmacists to discuss medication safety also are important.
More than ever, preventing readmission requires the involvement of a wide range of team members. For example, a recent study published in Medical Care Research and Review found that 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction were improved with the involvement of occupational therapy. The researchers found that occupational therapy was one spending category that affects both clinical and social determinants of health. View this study at http://mcr.sagepub.com/search/results?fulltext=occupational+therapy+readmissions&x=13&y=13&submit=yes&journal_set=spmcr&src=selected&andorexactfulltext=and.
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