Reduce readmissions with service-based care management.

Area of Science:

• Healthcare Management
• Clinical Quality Improvement
• Patient Outcomes

Background:

• The Affordable Care Act and Centers for Medicare & Medicaid Services (CMS) reimbursement penalties spurred focus on reducing hospital readmissions.
• Care management is integral to improving healthcare service, financial, and clinical outcomes.
• In 2008, an academic medical center in California restructured its care management from a unit-based to a service-based model.

Purpose of the Study:

• To assess the impact of a restructured service-based care management model on patient experience and clinical quality.
• To evaluate changes in readmission rates and patient satisfaction scores post-restructuring.

Main Methods:

• Retrospective analysis of hospital patient care services data from November 2008 to January 2010.
• Primary outcomes: all-cause and disease-related readmission rates.
• Secondary outcomes: Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) scores.
• Interrupted time series analysis comparing pre- and post-intervention periods.

Main Results:

• Disease-related readmission rates significantly decreased (5.43% to 4.58%, p < .05).
• All-cause readmissions showed a trend toward decrease (11.42% to 10.49%, p = .056).
• Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) "recommend this hospital" scores remained stable (78.9% to 77.8%, p = .267).
• Care management staffing remained stable despite an increase in average daily census (274 to 297).

Conclusions:

• Partnering care managers and social workers with physician services (service-based care management) can reduce hospital readmissions.
• This model has the potential to improve clinical quality without negatively impacting patient satisfaction.
• Effective readmission reduction and patient satisfaction are key for CMS value-based purchasing reimbursement.