Under the provisions of the Patient Protection and Affordable Care Act (PPACA), hospitals that have higher than expected readmission rates for Medicare patients that were admitted for the treatment of myocardial infarction, heart failure, or pneumonia will face reduced payments. Two recent studies on patient readmission suggest that readmissions may be reduced by improving nurses’ work environments, increasing staffing ratios, and ensuring that patients talk with a nurse weekly after discharge.
Improving nurses’ work environments
Improving nurses’ work environments and reducing their workloads can reduce readmissions for Medicare patients with common conditions, according to Matthew McHugh, PhD, JD, MPH, RN, FAAN, Assistant Professor at the University of Pennsylvania School of Nursing. McHugh conducted a study to determine the relationship between the nurses’ work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare beneficiaries with heart failure, acute myocardial infarction, and pneumonia.
The study found that “care in a hospital with a good versus poor environment was associated with odds that were seven percent lower for heart failure, six percent lower for myocardial infarction, and 10 percent lower for pneumonia.” According to the research, nearly 1 quarter of heart failure index admissions, 19.1 percent of myocardial infarction admissions, and 17.8 percent of pneumonia admissions were readmitted within 30 days. For each patient added to the average nurse’s workload there was an associated increase in the odds of readmission within 30 days of discharge—7 percent for patients with heart failure, 6 percent for pneumonia, and 9 percent for myocardial infarction patients. The study, which was published in the January 2013 issue of Medical Care, was funded by the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program.
Coordinated Transitional Care program
Weekly telephone contact with a nurse before and after discharge substantially reduced hospital readmissions for high-risk patients and saved money, according to a study discussed in an article on Nurse.com and Health Affairs. The study, which was conducted by researchers associated with the University of Wisconsin School of Medicine and Public Health and the Geriatrics Research, Education, and Clinical Center (GRECC) at the William S. Middleton Memorial Veterans Hospital, examined the Coordinated Transitional Care (C-TraC) Program. The C-TraC Program was designed to improve care coordination and outcomes among veterans with high-risk conditions discharged to community settings from the Veterans Hospital. The program involved nurse case managers working with patients on care and health issues, including medication reconciliation, before and after hospital discharge. Once the patient was at home, all contacts were made by phone. Patients who participated in the program experienced one-third fewer re-hospitalizations than those in a baseline comparison group. In addition, health care costs decreased by about $1,225 for each patient enrolled in the program compared with similar patients who were not enrolled. The researchers estimated that during the first 18 months of the program, the hospital saved $741,125 in health care costs. They noted that this model requires relatively few resources to operate and may represent a viable alternative for hospitals that would like to offer improved transitional care as encouraged by PPACA. They also noted that providers in rural areas or other care settings challenged by wide geographic dispersion of patients or by constrained resources also may find this model useful.