Annotated Bibliography for Reducing Re-hospitalization
Hakim, R.M., & Collins, A.J., Reducing Avoidable Rehospitalization in ESRD: A Shared Accountability. Journal of the American Society of Nephrology. 2014; 25(9): 1891–1893
In this article, Hakim and Collins (2014) provide a critical review of the measures that can be employed to reduce the rates of re-admission in hospitals, particularly of patients with End Stage Renal Disease (ESRD). For instance, the propose that the provision of medical reconciliation after discharging a patient is essential due to the fact that covers of the aspects of care. For instance, the patients with ESRD experience medical related problems, which are particular severe at the time when they are discharged from the hospital due to the fact that the process mostly involves changes to the medication that is prescribed for pre-hospitalization. In this case, the involvement of a pharmacist is critical in the identification of the actual and potential medical related problems and also significantly reduces hospitalization and the duration of stay of dialysis of the patients.
They also proposed that nutritional deterioration is another critical factor that needs to be addressed in relation to early post-hospital care after discharge. The delicateness of the nutritional status of dialysis patients is quite appreciated with hospitalization adding onto that burden. Hakim and Collins (2014) prescribe oral nutritional supplements, which need to be provided to the patient immediately after they return for dialysis, which significantly reduces not just the rate of re-hospitalization but also mortality. They therefore, concluded that additional intervention by the health care team can result into reduced re-hospitalization is there is prompt communication between the outpatient dialysis unit and the attending nephrologist. Another favorable condition is that there also need to be prompt evaluation of the condition of the patient by the nephrologist that should be conducted within a timeframe of not more than two dialysis.
Kripalani, S., Theobald, C.N., Anctil, B., &Vasilevski, E.E., Reducing Hospital Readmission: Current Strategies and Future Directions. Annual Review of Medicine.2014; 65: 471–485.
In this article, Kriplani et al. (2014) review the financial penalties that have been imposed on the healthcare institutions that have high records of readmission in a bid to reduce the re-hospitalization rates. In particular, they look into the numerous interventions, which include multiple components such as medication reconciliation, the following up of the discharge patients over the telephone, education of patients and the arrangement of timely appointment for the discharged patients. They observe that these multiple components have proved to significantly reduce the rates of readmission for the discharged patients who are convalescing at home.
More specifically, Kriplani et al. (2014) note that the effects of these interventions is directly affected by the number of the implemented components. This implies that the use of single component interventions is highly unlikely to reduce the rates of patients’ readmission to the healthcare institutions. More specifically, studies have proved that the patients that are discharged from post-acute healthcare facilities require multi-component interventions, through taking into account elements such as advanced care planning, enhanced communication, enhanced training for managing the medical conditions that usually precipitate readmission and through the provision of medical safety.
Kriplani et al. (2014) conclude that in order for health care institutions to avoid penalties that arise from high re-admission rates they need to embrace multifaceted interventions, which demand substantial resources to plan, implement and monitor the programs. Even though transitional medical care may prove cost-effective in certain contexts, health care institutions have to determine various factor, which include their current level of performance and the amount of money they can recoup from financial penalties. Besides, the institutions also need to consider the resources that they have at hand and whether they require additional resources to allocate to aid the reduction of readmission with specific regard to safety and quality of the initiatives. Hospitals should therefore, focus their energies on the patients that are at a higher risk of readmission and should therefore, identify them based on characteristics such as polypharmacy, advanced age or their decreased functional status. They may also identify them through the use of predictive models, which quantify the readmission risks.
White B., Carney, P., Flynn, J., Marino, M., & Fields, S., Reducing hospital readmissions through primary care practice transformation. Journal of Family Practice. 2014, 63(2):67–73.
In this article White et al (2014) discuss the findings of their study in which they were conducting an assessment of the effects of multicomponent interventions on a month long hospital re-admission amongst of a group of primary care practices, which employed practice transformation. They then compared this to the rates reported in the usual care practices of the patients admitted in the same hospital service. Their study involved four primary care clinics that provide enhanced care with the inpatient care teams and the care managers. They also developed and used the hospital readmission reports for monitoring the readmission rates of the patients over a period of about 12 months. Their study involved patients that were cared for by a group of primary care clinics that used transformative activities while the other group of patients were those that attended the clinics that did not use any practice redesigned activities. Therefore, White et al. (2014) concluded that the development of a multicomponent intervention has a significant effect in reducing the rate of hospital readmission. It is therefore, imperative that primary care groups that are seeking to cut down on the rates of readmission consider using the multicomponent intervention programs.
