Inside this Issue:      Hospital Readmission...      Earth Day Celebration      Cartoon of the Month

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Hospital Readmission of Elders Due to Multiple Causes MOST CASES UNAVOIDABLE AS COMPLEX ISSUES ARE NOT AS SIMPLE AS THEY SEEM The elderly have high risk of acute hospital admission and are frequently readmitted soon after discharge, says a recent study done by the University of Texas. Data from a number of other reports would seem to support this claim. For example, government statistics indicate that nearly twenty-percent of Medicare patients discharged from hospitals are readmitted within thirty days; and a more local study indicated that nearly fifty-percent of elder patients admitted to hospitals in NH were readmitted within one year. While not all readmissions are preventable, the high cost—both in terms of dollars and impact on the patient—suggests that even a small reduction in preventable admissions or readmissions would result in a substantial contribution to lowering healthcare costs while improving care levels. The Rest of the Story... But before casting blame or looking for solutions, taking a close look at the most common root-causes for readmission might reveal a few surprises as well as a more well-defined path for improving the overall processes involved. Despite common misconceptions, a review of actual statistics will quickly reveal that most readmissions are attributable to un-modifiable causes. In fact, global readmission rates are not a useful indicator of quality of care, as fewer than half can be traced to substandard care during the index hospitalization and most can be directly related to patient-specific issues. While high readmission rates of patients with defined conditions, such as diabetes and bronchial asthma, may identify quality of care problems in those specific areas, generalized data is less definitive. Higher rates of readmissions also exist for geriatric patients, but the highest rates are observed in "high risk" or severely ill geriatric patients, mostly those suffering with heart failure and COPD. On a more general basis, further research shows the primary independent predictors of readmissions to be age, length of stay and previous use of hospital resources. In addition, male sex, race, supplemental Medicaid coverage, low socioeconomic status, single marital status, psychiatric co-morbidity, behavior problems, severity of illness, nutritional status and geographic covariates all have an impact on the likelihood of readmission, as will the quality of post-discharge rehabilitation care. This indicates that patient-specific factors predict readmissions — some are non-modifiable and others, such as compliance with post-discharge therapy or with prescribed medications, might be. The significance of this data is, quite simply, that it might enable care providers to recognize likely candidates for readmission and to take preventative measures during the discharge process. A few possible steps to reduce readmission rates might include: Flag discharged patients who possess "readmission traits" as outlined above, and conduct a follow-up intervention within ten days of discharge to monitor compliance with discharge conditions or medication plans Schedule earlier post-discharge physician appointments for patients in the "high risk" group Inform post-discharge caregivers whenever a patient entering into their care is in the higher-risk category Identify post-discharge caregiver organizations that can document lower readmission rates Flag patients who are admitted with higher-risk conditions so that appropriate post-discharge interventions can be planned in advance Maintain more in-depth data when a patient is readmitted so that ongoing improvements can be made to the overall process    This Month's Cartoon Equally as significant is the data showing that readmissions do not necessarily reflect poor quality of care. This is critically important because once healthcare leaders acknowledge this fact they will be much more likely to allocate resources to studying and improving the real root causes. Top of Page Earth Day Celebration at Maristhill! Maristhill will be celebrating Earth Day on Tuesday April 21, and you are welcome to join us for the festivities! More details will be available soon, but we’re planning a Healthy High-Tea, tree-planting ceremony, Earth Day trivia, and other earth-friendly activities for residents, family and friends. Live entertainment by Tony Funches will also be featured. For additional information please contact Mary Christin at (781) 893-0240.   Maristhill Nursing & Rehabilitation Center - 66 Newton St - Waltham, MA - [781] 893-0240 www.maristhill.org