Is it time for health policy leaders, and leaders of patient care organizations, to move beyond reducing inpatient readmissions as a central measure of quality performance? three doctors who are leaders of JAMA network.
In fact, the very title of an article by Peter Cram, M.D., Robert M. Wachter, M.D., and Bruce E. Landon, M.D., is conveyed in the article headline, “Reduction in Readmissions as a Measure of Hospital Quality: Travel Time.” . To more pressing concerns?”—This was published online in the “Viewpoint” section. JAMA network October 6th.
In addition, these are prominent physicians, most notably Dr. Wachter, chairman of the University of California, San Francisco School of Medicine, and author of the famous 2017 book. The Digital Doctor: Hope, Hype, and Harm in the Computer Age at the Dawn of MedicineMeanwhile, Dr. Cram is Chair of the Department of Internal Medicine at the University of Texas Medical School (UTMB) in Galveston. Dr. Landon is Professor of Health Policy in the Department of Health Policy at Harvard Medical School. Dr. Landon is a professor of medicine and Beth He is a practicing physician at Israel Deaconess Medical Center (Boston).
And these three health policy leaders wrote in a JAMA Network op-ed: , had minimal obvious advantages. In addition, HRRP [Hospital Readmissions Reduction Program] Clinicians and healthcare system leaders have been distracted by other critical quality issues. Like many other quality measures, HRRP is tied to gamesmanship (discussed below), and hospitals are working hard to minimize potential penalties in coding practices, admission processes, and protocols. behaves predictably. It’s time to refocus hospital quality improvement efforts where they are most effective and beneficial.
The author of this article states: Estimated cost is $41 billion annually. Researchers and policy makers speculated that if the majority of readmissions were caused by health system failure, they were due to inadequate treatment during initial hospitalization or failure to coordinate care after discharge. Especially since hospitals receive additional payments when patients are readmitted. The Jenks study did more than just focus on readmissions as a key indicator of inpatient care quality. The HRRP ultimately led him to be incorporated into the Affordable Care Act (ACA) in 2010, a specific policy with a payment reduction system created to punish hospitals with too high readmission rates. became.
But now? Cram, Wachter, and Landon write:[A] A growing body of literature now suggests that reported reductions in readmissions may be exaggerated. Wadhera et al. found that patients who had previously been readmitted were being treated in an observational state. Other researchers found that much of the reduction in readmissions could be explained by concurrent changes in billing standards. This allowed hospitals to submit more comorbid diagnoses when submitting claims, thereby increasing the expected number of readmissions. Furthermore, McWilliams et al. found that much of the reduction in readmissions could be explained by a concomitant reduction in hospitalization rates for all Medicare beneficiaries. Several studies have also reported that HRRP is associated with a small but significant increase in post-discharge mortality in patients with pneumonia and congestive heart failure, although this is controversial. . “
All these important factors add up: “In the decade since the introduction of HRRPs, there has been a greater understanding of why health care systems are having such a hard time preventing readmissions. found that less than 36% of early readmissions (within 7 days after discharge) and 23% of late readmissions (8–30 days after discharge) were preventable. Twenty-six percent of admissions identified a hospital as the ideal location to target these preventable readmissions, or 14% of early readmissions and 19% of late readmissions identified the patient’s home as the ideal location. Identified as ideal targets: outpatient clinics, 7% and 15%, respectively;and emergency departments, 4% in both.Also, in promoting readmission at both individual and hospital levels, health There is a significant increase in recognition of the significant contributions of detrimental and harmful social determinants of
In that context they write: An investment to improve the aspects of care that they can more directly control. “
Three doctors believe that measures based on reducing readmissions should not be eliminated entirely. “Rather, readmissions should continue to be measured and tracked, but the financial penalties associated with HRRP may be withdrawn,” they wrote. They phased out HRRPs over time and replaced them with “a much stronger evidence-based support than readmission,” identified by an expert panel at the U.S. Agency for Healthcare Research and Quality in 2013. It recommends that a set of “Patient Safety Practices” be considered for measurement. These measures were “preoperative surgical and anesthesia checklists, clinical bundles and ordered sets to prevent catheter-related infections, and expanded use of clinical pharmacists to reduce adverse drug events.” They add, “We also need to look at other opportunities for potential improvement, including clinician and hospital staff health, patient experience, addiction treatment services and palliative care.”
Finally, the author concludes: In 2022, after more than a decade of concerted effort, it is time to focus limited hospital resources on more manageable, evidence-based goals that are more directly under hospital control. rice field. “
