Hospital readmissions continue to be a major contributor to soaring healthcare costs and a drain on the U.S. economy. According to the Robert Wood Johnson Foundation, 4.4 million hospital readmissions account for $30 billion every year, while 20 percent of Medicare patients are expected to return to the hospital within 30 days of discharge. The Affordable Care Act of 2010 requires the U.S. Department of Health & Human Services to establish a readmission reduction program.
This program provides incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Centers for Medicare and Medicaid Services (CMS) has created quality programs that reward healthcare providers and hospitals with incentive payments for using electronic health records (EHR) to promote improved care quality and better care coordination. The reasons for hospital readmissions include adverse drug effects (ADE), lack of a proper follow-up care, inability of patients to understand the importance of their medications and diagnoses, unidentified root causes, and misdiagnosis. Technology could play a vital role here by properly documenting, tracking, diagnosing, monitoring, and enabling better communication between patient and provider.
Adverse drug events constitute the majority of hospital readmissions. A cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients indicated that 27.6 percent of these ADEs were preventable, of which 38 percent were serious or fatal. Human error was the leading contributor to these ADEs, followed by patient adherence. Additionally, patients who screened positive for depression were three times as likely to be readmitted compared to others.
Our analysis indicates that 28 percent of adult hospital stays involved a mental health condition. A study of Medicaid beneficiaries in New York State determined that, among patients at high risk of rehospitalization, 69 percent had a history of mental illness and 54 percent had a history of both mental illness and alcohol and substance use. We know that a properly implemented mental health screening protocol can lead to effective diagnosis, and that proper management of these issues can positively impact the reduction of hospital readmissions.
Further studies show that most cases of readmissions for certain chronic conditions have an underlying mental health issue, which appears in patients who have not been previously diagnosed for a mental health condition (i.e., anxiety, bipolar disorder or depression). For example, anxiety and/or depression increases the risk of stroke and decreases post-stroke survival, and plays a key role in diabetes treatment as 33 percent of this patient population is found to be depressed and patients with bipolar disorder have reduced life spans. Other cases where depression affects the patient’s survival and treatment cost include hypertension, stable coronary disorder, ischemia, unstable angina, post myocardial infarction and congestive heart failure.
An important point to note: congestive heart failure is the major driver of hospital readmissions in the U.S., accounting for 24.7 percent of all readmissions. Another study concluded that patients with severe anxiety had a threefold risk of cardiac-related readmission, compared to those without anxiety.
Guest post by Jennifer Dunphy, clinical subject matter expert, Get Real Health.
You would think Barbara must be feeling pretty glum. After all, cancer has been part of her life on and off since 1981. She is battling a recurrence of her breast cancer, on top of having had a radical mastectomy and uterine cancer.
Yet, when Barbara used an Internet-based mental health screening tool recently to assess her risk for mood or anxiety problems, she finished the test with a score of six — indicating a low probability of suffering from mental health issues.
As an oncology nurse, I’ve seen how cancer and other chronic diseases can affect a patient’s mental and emotional wellbeing, as well as how their mental health can have a huge impact on their physical response to treatment and their ability to recover. So, assessing patients’ mental health is just as important as tracking their vital signs and white blood-cell counts.
Unfortunately, mental health has always been a tricky subject for everyone involved in a cancer patient’s life — from the doctor and care team to the patient and his or her family and friends. Uncertainty and a lack of clear ground rules for how to even talk about it often result in people simply avoiding the topic.
“Cancer used to be considered a death sentence,” Barbara recalls, “so everyone tiptoed around it and you were encouraged not to talk about it. It was like a little secret.”
While that’s changed a little over the years, she believes better communication is still very much needed.
“I would (address) the emotional aspect early on as part of the intake process,” says Barbara. “The doctors should be more upfront in the beginning about how they communicate your situation.”
That’s good advice, but easier said than done. While some doctors and nurses seem to be naturally gifted in their ability to talk with patients warmly and holistically, I’ve seen many others struggle to communicate about topics beyond the strictly medical.
It’s tough for a lot of patients as well. Barbara has been strong enough emotionally to reach out when she needs information or support, but many other patients are as uncomfortable discussing mental and emotional health as their caregivers.
The hard part is just getting the conversation started. That’s where technology has a pivotal role to play — and it can be as simple and accessible as the nearest smartphone, tablet or computer.
The online mental health screening tool Barbara used is called WhatsMyM3. She said she found it “easy to work with and user friendly, even for someone with a low computer proficiency.”
That feedback was music to my ears, because mental health screening technology has to be simple, quick and accurate in order to be widely adopted and used effectively. It also must serve as a two-way communication bridge between the patient and physician.
The M3 score isn’t simply a number. It’s an invitation for the patient and caregiver to take the next step and talk in-depth about what the score means, how the patient is feeling, what questions the patient might have that he or she has bottled up out of fear or awkwardness.
In other words, the technology enables a very human conversation to ensue. It’s a great example of technology creating a path to healing that would not otherwise have easily or naturally opened up. And it’s a tool that the care team can use as often as it deems necessary with that patient — including daily monitoring and communication if indicated by a higher M3 score.
WhatsMyM3 is powered by a product called M3 Clinician, an evidence-based Web and mobile reimbursable mental health screening app for mood and anxiety disorders, which was developed by Rockville, Maryland-based M3 Information LLC.
(Full disclosure: M3 partnered with my company, Get Real Health, earlier this year to integrate the M3 app into our InstantPHR product — a flexible and interoperable suite of Web-based health tools for personal health, data visualization and care management.)
Living with a chronic disease like cancer taxes the coping skills of every patient. Using technology to track and hopefully improve mental and emotional wellbeing gives patients one more tool to use in fighting what is likely the biggest battle of their lives.