Evidence based processes to prevent readmissions: more is better, a ten-site observational study

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Patient Care Transitions

Background:

• 30-day hospital readmissions are a key quality indicator, with financial penalties for high rates.
• Evidence-based care transition processes are known to reduce readmissions.
• This study investigated the link between the number of implemented transitional care processes and risk-standardized readmission rates (RSRR).

Purpose of the Study:

• To examine the relationship between the number of evidence-based transitional care processes utilized and the risk-standardized readmission rate (RSRR).
• To identify which transitional care processes are most consistently implemented and which are underutilized across healthcare facilities.

Main Methods:

• A mixed-method, multi-stepped observational study was conducted across ten VA hospitals from 2014-2018.
• Data included semi-structured interviews (n=314) with staff and observations (n=105) of care transition processes.
• The frequency of use of twenty recommended processes was scored, and cumulative scores were correlated with RSRR.

Main Results:

• No hospital implemented all twenty recommended care transition processes.
• Pre-discharge patient education and medication reconciliation were universally performed.
• A higher total score for care transition processes significantly correlated with a lower RSRR (R²=0.61, p<0.007).

Conclusions:

• Increased utilization of evidence-based transitional care processes is associated with reduced hospital readmissions.
• Barriers to consistent process implementation exist, necessitating new strategies for workflow integration.
• Enhanced use of underutilized processes, patient involvement in discharge planning, community support, and dedicated bridging personnel are recommended for further readmission reduction.