Strategies to Reduce Hospital Readmissions

Abstract

After the Patient Protection and Affordable Care Act or “Obamacare” was signed into law in 2010, the problem of readmission has taken on a new sense of urgency. Hospitals with excess readmissions receive reduced reimbursement because readmission is considered to represent a poor quality measure in the healthcare delivery system. Cirrhosis places a major burden on the healthcare economy. Patients with cirrhosis frequently require hospitalization, and annual admission rates have doubled within 10 years. The costs of hospitalization associated with cirrhosis have also markedly increased. Readmissions create negative consequences for the patient and the family. Several strategies have been proposed to reduce the number of readmissions, but the efficacy of these strategies is questionable. Although the Model for End-Stage of Liver Disease (MELD) score can be a tool for risk stratification, many other factors are also independent risks for readmission. Studies aimed at the reduction of readmission in patients with cirrhosis are very limited, and much research is required before specific recommendations can be made to reduce readmissions.

Keywords

cirrhosis - readmission - complications of cirrhosis - healthcare delivery - MELD score

• References

• 1 Berman K, Tandra S, Forssell K , et al. Incidence and predictors of 30-day readmission among patients hospitalized for advanced liver disease. Clin Gastroenterol Hepatol 2011; 9 (3) 254-259
• 2 Chirapongsathorn S, Krittanawong C, Thongprayoon C , et al. 574 risk factors for readmission and poor outcomes in patients admitted with complications of cirrhosis. Gastroenterology 2015; 148 (4) (Suppl. 01) S-982
• 3 Volk ML, Tocco RS, Bazick J, Rakoski MO, Lok AS. Hospital readmissions among patients with decompensated cirrhosis. Am J Gastroenterol 2012; 107 (2) 247-252
• 4 Chirapongsathorn S, Kamath PS. Hospital readmissions in decompensated cirrhosis. Am J Gastroenterol 2015; 110 (6) 940
• 5 Moreau R, Jalan R, Gines P , et al; CANONIC Study Investigators of the EASL–CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144 (7) 1426-1437 , 1437.e1–1437.e9
• 6 Allen AM, Kim W, Moriarty JP , et al. The economic burden and mortality of patients with acute on chronic liver failure (ACLF) in the United States. Hepatology 2014; 60: 485A
• 7 Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010)
• 8 Centers for Medicare & Medicaid Services. Readmissions Reduction Program. Available at: http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/ . Accessed October 20, 2015
• 9 Hines AL, Barrett ML, Jiang HJ , et al. Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011: HCUP Statistic Brief #172. Rockville, MD: Agency for Healthcare Research and Quality; April 2014:1–10
• 10 Agency for Healthcare Research and Quality. National Statistics on All Stays. The Healthcare Cost and Utilization Project (HCUP) Available at: http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=6A512220FCED57C5&Form=DispTab&GoTo=MAINSEL&JS=Y#skip . Accessed October 14, 2015
• 11 Seyrig M. The economic cost of advanced liver disease. November 7, 2011. Available at: http://www.henryford.com/body.cfm?id=46335&action=detail&ref=1465 . Accessed August 2, 2015
• 12 Lawson EH, Hall BL, Louie R , et al. Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg 2013; 258 (1) 10-18
• 13 Emerson CB, Eyzaguirre LM, Albrecht JS, Comer AC, Harris AD, Furuno JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012; 33 (6) 539-544
• 14 O'Leary JG, Reddy KR, Wong F , et al; North American Consortium for the Study of End-Stage Liver Disease. Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis. Clin Gastroenterol Hepatol 2015; 13 (4) 753-9.e1 , 2
• 15 Reddy KR, O'Leary JG, Kamath PS , et al; North American Consortium for the Study of End-Stage Liver Disease. High risk of delisting or death in liver transplant candidates following infections: results from the North American Consortium for the Study of End-Stage Liver Disease. Liver Transpl 2015; 21 (7) 881-888
• 16 Leppin AL, Gionfriddo MR, Kessler M , et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med 2014; 174 (7) 1095-1107
• 17 Ratib S, Fleming KM, Crooks CJ, Walker AJ, West J. Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study. Am J Gastroenterol 2015; 110 (8) 1149-1158
• 18 Shepperd S, McClaran J, Phillips CO , et al. Discharge planning from hospital to home. Cochrane Database Syst Rev 2010; (1) CD000313
• 19 Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 1998; 158 (10) 1067-1072
• 20 Crossen-Sills J, Toomey I, Doherty M. Strategies to reduce unplanned hospitalizations of home healthcare patients: a STEP-BY-STEP APPROACH. Home Healthc Nurse 2006; 24 (6) 368-376
• 21 Rogers J, Perlic M, Madigan EA. The effect of frontloading visits on patient outcomes. Home Healthc Nurse 2007; 25 (2) 103-109
• 22 Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med 2001; 111 (9B) 26S-30S
• 23 Crocker JB, Crocker JT, Greenwald JL. Telephone follow-up as a primary care intervention for postdischarge outcomes improvement: a systematic review. Am J Med 2012; 125 (9) 915-921
• 24 Blum K, Gottlieb SS. The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. J Card Fail 2014; 20 (7) 513-521
• 25 Dar O, Riley J, Chapman C , et al. A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. Eur J Heart Fail 2009; 11 (3) 319-325
• 26 Chaudhry SI, Phillips CO, Stewart SS , et al. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail 2007; 13 (1) 56-62
• 27 Chaudhry SI, Mattera JA, Curtis JP , et al. Telemonitoring in patients with heart failure. N Engl J Med 2010; 363 (24) 2301-2309
• 28 Morando F, Maresio G, Piano S , et al. How to improve care in outpatients with cirrhosis and ascites: a new model of care coordination by consultant hepatologists. J Hepatol 2013; 59 (2) 257-264
• 29 Agency for Healthcare Research and Quality. Patient Safety Organization (PSO) Program: Reducing Unnecessary Hospital Readmissions: The Role of the Patient Safety Organization. Volume 2015. Rockville, MD: Agency for Healthcare Research and Quality; 2015
• 30 National Patient Safety Foundation. Strategic Plan of the National Patient Safety Foundation (NPSF). February 2014. Available at: http://www.npsf.org/?page=aboutus . Accessed September 14, 2015