While quality and patient safety initiatives are implemented to improve patient outcomes, they also typically include a financial cost which must be balanced with expected outcomes. This study compared hospitals’ financial performance (i.e., financial margin and risk of financial distress) and outcomes (i.e., 30-day readmission rates, patient safety indicator-90 (PSI-90)) using data from the American Hospital Association and Hospital Compare. Hospitals in the best quintiles of readmission rates and PSI-90 scores had higher operating margins compared to the lowest rated hospitals.
Muchiri S, Azadeh-Fard N, Pakdil F. J Patient Saf. 2022;18:237-244.
The Hospital Readmissions Reduction Program (HRRP), implemented by the Centers for Medicare & Medicaid Services (CMS), imposes a financial penalty on hospitals with higher than average readmission rates for certain conditions. Six years of readmission rates for four conditions included in the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, and pneumonia) and two conditions not included (septicemia and mood disorders) were analyzed to assess the impact of the HRRP. The researchers conclude the HRRP reduced readmission rates for the four targeted conditions, but reductions were not consistent across all categories of patients.
The Centers of Medicare & Medicaid Service (CMS) Hospital Readmissions and Reduction Program (HRRP) financially penalizes hospitals if patients with certain medical conditions are readmitted. This study analyzed the empirical approaches used in prior research to evaluate the effectiveness of the HRRP. The authors conclude that approaches used in some prior research lacked internal validity and may not indicate causal consequences of the program on readmissions.
Pinheiro LC, Reshetnyak E, Safford MM, et al. Med Care. 2021;59:901-906.
Prior research has found that racial/ethnic minorities may be at higher risk for adverse patient safety outcomes. This study evaluated racial disparities in self-reported adverse events based on cross-sectional survey data collected as part of a national, prospective cohort evaluating stroke mortality. Findings show that Black participants were significantly more likely to report a preventable adverse event attributable to poor care coordination (e.g., drug-drug interaction, emergency department visitor, or hospitalization) compared to White participants.
Pharmacist-led medication reconciliation has been found to reduce medication discrepancies for some patients. This retrospective study examined the impact of pharmacist-conducted medication reconciliation among patients with chronic obstructive pulmonary disease (COPD). While pharmacist-conducted medication reconciliation identified medication dosing and frequency errors, it did not reduce 30-day readmission rates for patients with COPD.
McHugh MD, Aiken LH, Sloane DM, et al. The Lancet. 2021;397:1905-1913.
While research shows that better nurse staffing ratios are associated with improved patient outcomes, policies setting minimum nurse-to-patient ratios in hospitals are rarely implemented. In 2016, select Queensland (Australia) hospitals implemented minimum nurse staffing ratios. Compared to hospitals that did not implement minimum nurse staffing ratios, length of stay, mortality, and readmission rates were significantly lower in intervention hospitals, providing evidence, once again, that minimum staffing ratios can improve patient outcomes.
Field TS, Fouayzi H, Crawford S, et al. J Am Med Dir Assoc. 2021;22:2196-2200.
Transitioning from hospital to nursing home (NH) can be a vulnerable time for patients. This study looked for potential associations between adverse events (AE) for NH residents following hospital discharge and NH facility characteristics (e.g., 5-star quality rating, ownership, bed size). Researchers found few associations with individual quality indicators and no association between the 5-star quality rating or composite quality score. Future research to reduce AEs during transition from hospital to NH should look beyond currently available quality measures.
Merkow RP, Shan Y, Gupta AR, et al. Jt Comm J Qual Patient Saf. 2020;46:558-564.
Postoperative complications can increase costs due to additional healthcare utilization such as further testing, reoperation, or additional clinical services. This study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to estimate 30-day costs resulting from postoperative complications. Prolonged ventilation, unplanned intubation, and renal failure were associated with the highest cost per event, whereas urinary tract infection, superficial surgical site infection, and venous thromboembolism were associated with the lowest cost per event.
Daliri S, Boujarfi S, el Mokaddam A, et al. BMJ Qual Saf. 2021;30:146-156.
This systematic review examined the effects of medication-related interventions on readmissions, medication errors, adverse drug events, medication adherence, and mortality. Meta-analyses indicate that medication-related interventions reduce 30-day readmissions and the positive effect increased with higher intervention intensities (e.g., additional intervention components). Additional research is required to determine the effects on adherence, mortality, and medication errors and adverse drug events.
This pilot study evaluated the impact of transitional care pharmacist medication-related interventions in skilled nursing settings on 30-day hospital readmissions. The intervention group received transitional services involving a pharmacist (such as medication reconciliation, coordination with the skill nursing case manager and physician, and patient/caregiver education) and the control group received transitional services without pharmacist involvement. Over the follow-up period, median time to readmission was significantly longer in the intervention group but 30-day readmission rates were non-statistically significantly lower in the intervention compared to control group.
Hochman M, Bourgoin A, Saluja S, et al. Rockville, MD: Agency for Healthcare Research and Quality; March 2019. AHRQ Publication No. 18(19)-0055-EF.
Programs are in place to address hospital discharge process gaps that contribute to readmissions. This report summarizes research on primary care perspectives on reducing readmissions. Interventions identified include automated alerting to primary care providers when patients are hospitalized and the patient-centered medical home model.
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