Reducing heart failure hospital readmissions from skilled nursing facilities.

Prof Case Manag. 2011 Jan-Feb;16(1):18-24

Authors: Jacobs B

PURPOSE/OBJECTIVES:: Readmission rates for heart failure patients are a Center for Medicare & Medicaid and Joint Commission core measure. At this urban Midwestern medical center, the 6-month baseline skilled nursing facility (SNF) readmission rate was 30%. Nurse case management implemented a process to decrease the rate for this population. Follow-up phone calls were in place for patients discharged to home, but a gap remained in those discharged to SNFs. Nurse case management developed a follow-up phone call process within 48 hours of discharge to the registered nurse/licensed practical nurse in the SNFs to verify that: PRIMARY PRACTICE SETTING:: Acute inpatient care settings.Findings/conclusions: The phone calls resulted in improved continuity of care and clarification of discharge orders. The opportunity for question-and-answer time between the hospital and the SNF nurse provided just-in-time education; relationships have also been strengthened. Recent data show that the current readmission rate averages 11.32% (a decrease from 30%). This nurse case management-driven process of follow-up phone calls between the hospital and SNF staff to reduce readmission rates in heart failure patients resulted in improved continuity of care and clarification of discharge orders. IMPLICATIONS FOR CM PRACTICE:: This simple, innovative process allowed for improved continuity of care and partnerships between inpatient hospitalization and the SNF, thereby reduced transcription errors and improved patient health outcomes. Enhanced communication between providers allowed for a significant reduction in readmissions from SNFs to the hospital.

PMID: 21164330 [PubMed - in process]

[Read more →]

Case Management Reform: An Illustrative Study of One Hospital’s Experience.

Prof Case Manag. 2010 Mar-Apr;15(2):79-89

Authors: Higgins J, Cole-Poklewski T

PRIMARY PRACTICE SETTINGS: This study describes reform of the case management department at Cooley Dickinson Hospital, a small community hospital in Western Massachusetts. METHODOLOGY AND SAMPLE: Based on Microsystems and Care Transition theory, the study is designed to answer 2 primary research questions: (1) What is study participants’ perceived value of the recent departmental changes? and (2) What effect have the changes had on participants’ work experience? A sample of case management department staff members and several other hospital staff members were interviewed near the end of the 18-month reform process, in March 2009. RESULTS: Results of these interviews indicate that despite a departmentwide reduction in force in November 2008, case management productivity levels have increased and satisfaction levels remain strong. It is strongly believed by study observers that because the changes used proven theories, the efficiencies and satisfaction that were realized can be duplicated in other settings. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE AND RESEARCH: Findings have practical implications for the use of a model similar to the Congestive Heart Failure program model to improve care transitions across multiple sites through a patient-centered team approach. In particular, findings underscore the importance of improved use of information technologies for a more efficient transmission of information to postacute providers and the use of follow-up telephone calls. Another practical implication is the benefit of education of hospital staff about the impact the case management department has on the hospital as a whole. Improved education of hospitalists, specifically, has resulted in earlier communication on the nursing units and more efficient discharge processes. There are also implications for research, such as the need for further research on the effects of patient-centered care for reducing readmission and on the definition and treatment of complex cases across hospital units.

PMID: 20234291 [PubMed - in process]

[Read more →]

Related Articles

Reducing unnecessary admissions related to 1-day stays: a collaborative effort.

Prof Case Manag. 2008 Nov-Dec;13(6):318-28; quiz 329-30

Authors: Helderman M, Kraemer YL, Dyer J, Davis HS, Firestone M

PURPOSE: To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals PRIMARY PRACTICE SETTING: Acute care hospitals. METHODOLOGY AND SAMPLE: The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, 141, 143, 182, and 183 was obtained from each participating hospital. Claims with discharge dispositions of 02 (transfers), 07 (left against medical advice), 20 (expired), and 66 (transferred to a critical access hospital) were excluded. RESULTS: Seventeen acute care hospitals in Indiana collaborated with the quality improvement organization in reducing unnecessary admissions for the focused 1-day LOS admissions. The study resulted in a 2.6% relative improvement from baseline to remeasurement with an estimated overpayment of $1,494,294. In addition, there was a 42.6% decrease from baseline to remeasurement in the total number of claims meeting the study criteria. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In many instances, case management can impact the following findings: Medical records sampled for this study, focusing on 1-day LOS, lacked documentation to support medical necessity for an inpatient admission. Diagnosis-related groups related to symptoms, such as DRG 143 (chest pain), are at high risk for not meeting admission necessity. The majority of patients admitted to an inpatient stay with complaints of chest pain-like symptoms were admitted through the emergency department. Lack of medical necessity for an acute inpatient admission is a potential risk for denial, impacting the revenue cycle and patient satisfaction. Outpatient observation should be utilized when evaluating an unconfirmed diagnosis.

PMID: 19008757 [PubMed - indexed for MEDLINE]

[Read more →]