Readmission Prevention: A Top Priority at Highland
Highland continues to pursue initiatives to prevent hospital readmissions, an important quality measure in our health care system and a key factor in determining Center for Medicare/Medicaid (CMS) reimbursement rates.
Highland has formed several committees to examine reasons for readmission within a 30-day threshold and help develop and implement solutions. The teams focus on patients with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) diagnoses and the hospital is also part of an Accountable Health Partners (AHP) committee that examines what can be done to connect inpatient and outpatient systems to help reduce hospitalization.
A number of factors determine if the patient is ready for discharge and will be low risk for readmission. Key questions include: Does the patient understand discharge instructions? Is there a language or literacy barrier? Can the patient be contacted easily? Is a primary care physician appointment set up within one week of discharge? Is transportation to appointments available? Is a home health agency referral needed?
Other factors are weighed based on the patient diagnosis. “For patients with COPD we have additional components to consider and we work closely with Respiratory Therapy, Pharmacy and care coordinators in the process,” said Sullafa Kadura, M.D., who is part of the COPD Readmissions Reduction Committee. “For instance, we have found that about 60 percent of COPD patients admitted to the hospital don’t know how to use their inhalers correctly. Our respiratory therapists teach patients how to properly use inhalers with a spacer. Our pharmacists and care coordinators make sure the medications are affordable prior to discharge.”
Highland care coordinators contact PCP offices and their care managers about the patient hospital stay, and discuss the barriers identified in a verbal handoff on COPD and CHF patients. Care coordinators also help ensure that patients have the proper equipment – that oxygen tanks, Cpaps and nebulizers are in working order. If not, physicians write prescriptions for new equipment.
Readmission prevention is an ongoing process at Highland. “We keep working to standardize, implement, and improve our best practices for safe discharge of our patients,” said Dr. Kadura.