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Combating hospital readmissions: better communication, follow-up

Readmissions after a recent hospitalization are the bane of elderly patients — and hospitals, nursing homes and other agencies are finding ways to avoid them.

A national study of readmissions that included Omaha discovered that various tactics, including better communication and follow-up, make a difference.

The study, published this week in the Journal of the American Medical Association, compared hospital readmissions for Medicare patients from 2006 through 2008 to readmissions after improvements were made from 2009 through 2010.

The rate of readmissions within 30 days of discharge declined in the 14 test cities by about 6 percent. In Omaha, they declined by 6.2 percent.

One physician involved in the study, Dr. Joanne Lynn of Washington, D.C., said responsibility also rests with the patient and loved ones. They should no longer be “scared to speak up” to medical providers, Lynn said.

“And the time has come to say, 'No, I really don't know what to do for my mother. You've got to stop and tell me,'” Lynn said.

Methodist Hospital in Omaha sent staffers to four nursing homes, and the nursing homes sent staffers to the hospital, to better understand each other's challenges.

“We both had a realization that we had very different needs,” said Mary Hamilton, a director at Methodist. Computer and paper reports about a patient's being transferred to a nursing facility didn't always suffice. Now a nurse at the hospital calls a nurse at each of the four facilities to describe the patient's needs and treatment plan, said Kevin Rochford, a Methodist administrator.

Hospitals also have a financial motivation for reducing readmissions among Medicare patients. Beginning last fall, Medicare may penalize hospitals thousands of dollars for high readmission rates among patients treated for heart attacks, heart failure and pneumonia.

The Omaha project involved seven hospitals, 27 nursing facilities and 21 home health agencies. CIMRO of Nebraska, the state's Medicare quality improvement agency, oversaw the effort. Competing entities showed a willingness to come together and learn from each other, said Keri McDermott, spokeswoman for CIMRO.

Among the many ways to reduce the odds that a patient will quickly return to the hospital are: Making sure medication orders are clear; seeing that patients promptly follow up with their primary care physicians; making sure that the warning signs of slumping health are clearly conveyed to the patient and loved ones; using an effective checklist for nursing home staffers who monitor residents' health; having social workers assess the home environment for trip hazards; and other risks and needs.

Mary Ellen Dalton, president of the American Health Quality Association, said the study left no doubt of the effectiveness of the strategies. “The project was a success,” she said.

Contact the writer: 402-444-1123, rick.ruggles@owh.com

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