Reviewing raw numbers of hospital readmissions rather than just the percentage can make the process of managing rehospitalizations more manageable, notes Joshua Brewster, director of care management at Regions Hospital, a HealthPartners hospital.
Regions Hospital not only looks at the percent of readmissions, but also at the actual number of readmissions. This was one of those ‘aha’ moments that the organization had; the suggestion came from somebody outside of the organization who was visiting us. The individual said, ‘Have you ever looked at the raw number of readmissions rather than the percent?’ Because the percent for something like AMI, as we saw when we reviewed our data, bounces all over in CAHPS because we have such a small end size.
The additional benefit of taking a look, not just at the percentage, but at the raw numbers, is that it feels very manageable. So we often would be in meetings where we would talk about the most recent readmission rate, and it would feel overwhelming. And if we saw that the AMI rate had jumped up to 25 percent, that really put a damper on the discussions. But when we could dive into it and say, ‘Well this is only three or four patients, it feels much more manageable.’ But it also puts the entire readmission number into perspective for us.
If you divide how many readmissions we have by the number of units and the number of days, we are really talking about each unit in the hospital preventing one or two readmissions each week. It’s not that they have to do a lot of work with a lot of patients; it’s about just targeting the right patients and being very mindful of how we can make a difference by doing some little things. We can make a difference in the patient’s experience, but we can also make a big difference in the overall numbers for readmissions.
We also have taken a look and seen that the group of ‘other’ is a big number; right around 120 readmissions each month fall into this group of ‘other.’ We’ve looked at that every which way to identify if there are some populations or trends within that group, some ways that we can dig into that further, and we just can’t. It’s a very non-homogenous group; there’s no way that we can split it out. We have taken the approach that not only do we need to sometimes look at the specific diagnoses, but also, let’s find interventions that impact all patients as they discharge, because that’s where the bang for the buck is going to be. We could reduce our COPD readmissions rate to zero, and our overall readmissions wouldn’t look much different.
Rethinking Readmissions: Patient-Centered Collaborations in Care Transition Management examines the data analytics driving the CMS Care Transitions Demonstration Project as well as some home-grown programs that are supporting patients’ seamless transitions back into their communities.