Better Quality of Care Improves Patient’s Health and Saves Money

The debate over the last few years on health care policy has centered on how can savings be achieved while improving the quality of care. Three studies of late have shown that improving the quality of care in three areas can result in better care at reduced cost primarily by reducing readmission to a hospital.  A study conducted by the Minneapolis Heart Institute (MHI) has shown that the care provided by a cardiologists as opposed to care provided by a hospitalist reduces hospital readmissions by ten percent.  A study published in the October-December issue of Advances in Nursing Science has found that effective home care following a hospitalization can reduce readmission rates as well.  A third study conducted by the American Hospital Association (AHA) and the Center to Advance Palliative Care (CAPC) has shown that the use of palliative care by hospitals leads to better care, reduced readmissions and overall savings in the provision of care.

Specialist Care

MHI determined that patients with congestive heart failure (CHF) were hospitalized less when their attending physician was a cardiologist.  CHF patients 65 years and older are the most likely patients to be readmitted to a hospital. MHI studied the rehospitalization rates of 2,311 patient with CHF admitted to a hospital from January 1, 2009 to December 31, 2011. Of these patients 65 percent were treated by a hospitalist and 35 percent were treated by a cardiologist. The readmission rate for patients treated by a cardiologist was 16 percent and the readmission rate for patients treated by a hospitalist was 27 percent. Readmission in this study was defined as being readmitted to a hospital within 30 days of discharge.

Home Health Care

Male home health patients who lived alone, had a higher cognitive ability score, and received more care from an informal caregiver had the least possibility for rehospitalization according to a study published in the October-December 2012 edition of Advances in Nursing Sciences.  Increasing age, obesity, lower levels of cognitive functioning and less care from informal caregivers resulted in more readmittance to hospitals.  Rehospitalization rates among home health care patients has been high with 1 in 4 patients who are discharged from the hospital needing to be readmitted to a hospital within 60 days of discharge, according to CMS. The quality of care provided and the social environmental setting in which home health care is provided does have an impact on the readmission rate of home health patients.

Palliative Care

Palliative care focuses on providing relief from symptoms, pain and stress in order to improve the patient’s quality of life.  More than 1,600 hospitals in 2010 provided palliative care. The AHA/CAPC study stated that patients with one or more  serious or chronic conditions represented 5 percent of the total patient population, but accounted for more than half of all health care costs.  These patients are at the highest risk for readmission.

One large hospital in Virginia, Inova Health System, found that the readmission rate for patients receiving palliative care was between 5 and 8 percent compared to the bench-mark of 20 percent for all Medicare fee-for-service patients.  Inova provided palliative care integration early on in a patient’s diagnosis and attributes this early use of palliative care to the reduction in avoidable hospitalizations.  AHA and CAPC reported that a study of eight hospitals found savings from the use of palliative care.  The average cost for palliative patients who died while receiving care was $4,908 per admission and the cost of care for palliative patients who were discharged was on average $1,696 per admission.

Improving the quality of care reduces costs was the conclusion of a Trendwatch article published by the AHA.  The article concluded that by developing effective strategies to improve quality of care, patient outcomes were improved at national, state and regional levels.  Improved quality of care lead to safer care at reduced cost.  The Trendwatch article identified numerous case studies in a variety of care regimens where this goal was accomplished.