A brand new research from researchers at Vanderbilt University Medical Center discovered that hospitals with a higher native provide of residence well being companies had been related with elevated readmissions.
One of the explanations readmission charges had been increased in these areas could also be on account of frequent staffing modifications and different interruptions in care, in accordance with the research’s lead writer.
“Some of this could be that different types of patients are discharged to home health versus other facilities,” Kevin Griffith, assistant professor with the division of well being coverage at Vanderbilt University Medical Center, advised Home Health Care News. “But one thing that has been noted in other research, as well as ours, is that in home health agencies, you’re more likely to have frequent staffing changes.”
Hospital readmissions are repeatedly seen as an indicator of the standard of care sufferers obtain. The Centers for Medicare & Medicaid Services (CMS) calculates annual readmission charges, and if these charges are increased than nationwide averages, hospitals are financially penalized.
However, CMS doesn’t consider whether or not a affected person’s danger for readmission is influenced by the supply of follow-up care after a affected person is discharged of their geographical space.
“The quality and the type of care you receive after you leave the hospital depends a lot on where you live,” Griffith stated. “If you live in an isolated, rural area, you may have no choice but to return to the emergency room if you’ve experienced complications. Yet the federal government does not currently account for this when they’re deciding what hospitals should receive penalties for excess readmissions.”
Griffith and his co-authors took a more in-depth have a look at this relationship by pairing county-level information on the well being care workforce and infrastructure with the 30-day readmission charges for coronary heart assault, coronary heart failure and pneumonia at hospitals from 2013 to 2019.
On common, a hospital’s surrounding space within the research contained over 620 SNF beds, about 25 main care physicians, 49 nurse practitioners, 19 licensed nursing residence beds and about 4 residence well being companies per 100,000 residents.
The research’s outcomes confirmed decrease 30-day readmission charges at hospitals that operated a palliative care service or had a higher native provide of main care physicians, expert nursing facility beds and licensed nursing residence beds.
For residence well being companies, it was one other story.
“Most of the results made sense to us,” Griffith stated. “We were kind of surprised that for home health agencies and the supply of nurse practitioners in an area, those were associated with higher hospital readmissions.”
Griffith hypothesized that when dealing with a discontinuity of care — like is widespread in residence well being — the prospect of rehospitalization will increase.
“When you have a patient recovering after a hospital stay, it’s always better if the same person is looking after them with the same team,” Griffith stated. “With home health, you’re more likely to have that person swapped out than if you’re at a skilled nursing facility or having your care managed by your primary care physician. That provides a lot of opportunities for the ball to be dropped.”
Another facet of the upper readmission charges may very well be the familiarity a caregiver has with a affected person as soon as she or he is discharged.
“When you get to know a patient, you are better at discerning what is a potentially worrisome complication versus what’s more normal for that patient,” Griffith stated. “We think there’s also a level of risk aversion. If you’re a new nurse being sent out to see a patient for the first time and see something concerning, you might send them to the emergency room. Somebody who has been working with them for a long time might know it’s more normal and not necessarily a cause for concern.”
Ultimately, the research discovered that CMS could also be penalizing or rewarding hospitals partly primarily based on the communities they serve versus the standard of care they supply.
“The results also suggest that hospitals may benefit from work to improve local access to care or hospital-community partnerships to improve continuity of care after a patient’s discharge,” the authors wrote.
For residence well being companies, Griffith steered leaders ought to higher observe readmission charges and work out methods to cut back them.
Like hospitals and expert nursing services, residence well being companies would possibly quickly see a rise in federal oversight, particularly because the sector has grown a lot, Griffith stated.
Tracking the information themselves may very well be a key in fixing the problem.
“What gets measured gets done,” Griffith stated. “If this is something you’re not even tracking, that’s problematic. The results show that maybe the sector could do some digging and ask, ‘What is it about these patients? What could we change about the way home health is delivered that might reduce these unwanted readmissions?’”
