With looming cuts to Medicare payments for preventable readmissions, hospitals are stepping up efforts to improve discharge planning and follow-up once patients go home, today’s Informed Patient column reports . So many organizations are jumping into the readmissions space that the Commonwealth Fund and the John A Hartford Foundation last year funded an “action guide” to help health care executives sort through the programs. One solution getting growing attention is Project Red — for Re-Engineered Discharge — developed by Boston University; in a study at Boston University Medical Center the program and its after-hospital care plan for patients reduced readmissions by 30%. Brian Jack, the Boston University researcher who developed RED, tells the Health Blog that under a new contract with the federal Agency for Healthcare Research and Quality his team is developing a toolkit explaining how to implement the program and is testing different implementation strategies at 10 hospitals. “What we are learning is that it’s not so easy to translate randomized trials using research methods to the real world of hospitals,” Jack says. “Changing the culture of hospitals and how they do things is difficult, even if we know, as we do with preparing patients for discharge, that new methods will improve care, increase satisfaction, lower rehospitalization rates and save money.” Bu thanks to the “enormous interests in readmissions and changing financial incentives,” he adds, “it is now happening.” Hospitals can download free tools to help develop after-hospital care programs on Project Red’s website and Joint Commission Resources , in a program funded by AHRQ, is offering training, planning and implementation help to participating hospitals. JCR, the non-profit arm of the leading hospital accreditation agency, says it has enrolled 225 institutions and has slots for 25 more under current funding. Some hospitals are also choosing to purchase a software program that uses RED’s tools to create a soup-to-nuts discharge program. It includes the use of a “virtual discharge advocate” named Louise, who appears as an animated character on an interactive screen rolled up to a patient’s bedside to help in the discharge process. Under a license with Boston University, San Francisco-based Engineered Care installs the system for about $30,000, according to chief executive Chris Corio. Corio, who says the company is currently working with about 15 hospitals, says that despite planned Medicare payment cuts, only the worst-performing hospitals will be penalized for high readmissions. So most hospitals “have little direct financial incentive to reduce their readmission rate,” he tells the Health Blog. And because such changes involve overhauling existing work processes around the hospital, “this can result in everything from loss of productivity during training to the nursing staff just being upset and vocal” about new procedures, he says. Once electronic medical records are more closely integrated into hospitals, such changes will be easier to make, he adds. Image: iStockphoto
