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Incorporating patients into the care team and providing written instructions are key patient engagement strategies during follow-up care that will reduce hospital readmissions.

An article from Patient Engagement HIT by Sara Heath on August 10, 2017

Incorporating patients into the care experience and offering explicit recovery instructions are important patient engagement strategies that can help healthcare organizations reduce unplanned hospital readmissions, according to a study published in the journal Patient Experience.

Reducing preventable hospital readmissions is a key indicator of quality healthcare, the research team explained. Currently, CMS enacts the Hospital Readmission Reduction Program, which is a value-based care model that drives payment penalties when hospitals exceed a benchmark hospital readmission rate.

Hospital readmissions, regardless of when they occur, can be extremely costly for hospitals and healthcare payers. In theory, delivering patient-centered and coordinated healthcare during the discharge process reduces the likelihood of hospital readmissions.

“Based upon this, our goal was to examine the potential associations between patient-reported aspects of communication and discharge care with unplanned readmissions up to one year post-discharge,” the research team explained.

The research team conducted a retrospective, cross-sectional analysis of HCAHPS scores and hospital readmissions rates. The team looked at HCAHPS questions specific pertaining to the following items:

  • Patient involvement in care decisions
  • Patients receiving written information at discharge
  • Patients understanding the purpose of taking medications
  • Patients understanding their responsibility in managing their health
  • Patients discussing help needed when returning home

HCAHPS is the “gold standard” in patient experience reporting and thus offered valuable and reliable insights into patient care during the discharge process, the researchers asserted.

After examining HCAHPS scores from nearly 25,000 patients and identifying unplanned hospital readmissions between April 2011 and March 2014, the researchers identified moderate correlation between discharge experience and readmissions.

In total, 18.6 percent of patients experienced an unplanned hospital readmission between 43 and 365 days following their initial discharge.

Patients who reported on their HCAHPS surveys that they were not involved in their care during the original encounter were 34 percent more likely to face readmission. Additionally, patients who did not report receiving written instructions during discharge were 24 percent more likely to see hospital readmission.

Combined, these two factors drive a 54 percent increase in likelihood for a patient hospital readmission, the researchers found.

Odds of hospital readmission did not change when looking at patient understanding of medications, knowledge about personal responsibility for recovery, and discussion of help needed upon return home.

On the whole, these results disproved the researchers’ original hypothesis. Only two quality care and discharge characteristics impacted hospital readmission, while the researchers initially posited that all factors would contribute to readmission.

However, the team said their findings were nonetheless valuable because they highlighted the importance of integrating the patient into the care team and offering concrete instructions for self-care.

Additionally, the results highlighted a new mechanism for identifying quality improvement processes, the team said.

“Our results reinforce that linking HCAHPS surveys to administrative data for quality improvement purposes is both feasible and useful,” the researchers said. “However, we advocate that, whenever possible, such linkages should be made at the individual-level.”

For example, the researchers suggested a follow-up study about the effects of patient-provider communication on hospital readmission. Such investigations could inform a checklist for providers to follow during the care encounter.

The researchers also said it was notable that patient reports of care quality can be useful for quality improvement.

“Our findings provide objective data which can be easily actioned upon for quality improvement purposes,” the team concluded. “Perhaps more importantly, our results reinforce that elements of patient reports of their hospital experience are indeed linked with more traditional, objective hospital outcomes.”

In addition to incorporating the patient as a partner in care and providing written instructions for follow-up self-care, separate research has indicated many strategies for reducing hospital readmissions. For example, incorporating family members as a part of the care team can reduce hospital readmission by up to 25 percent.

Additionally, offering convenient opportunities for patients to engage with follow-up providers – such as through mHealth technology or telehealth – can be helpful in ensuring patients are adhering to self-care management plans.