Electronic Health Reporter

Guest post by Dane D. Hallberg, strategic advisor, M3 Information.

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.

So, the factors that contribute to readmission are complex and must be viewed as a group. Research supports the conclusion that managing underlying mental health disorders or behavioral health could significantly reduce readmissions by improving quality of care and reduction in mortality.

Technology could play a vital role in tackling these issues. M3 Clinician is one such solution that is being used in primary care practices in the U.S. and abroad to operationalize this requirement. M3 is a highly efficient patient-rated screen that is NCQA pre-validated for the medical home. The patient rated 3-minute test effectively screens for depression, bipolar disorder and a range of anxiety disorders, including PTSD, using a single 27-item, patient-rated, evidence-based screen. M3 helps the provider identify potential issues and avoid mistreatment while facilitating better communication between patient and provider. Each step of the M3 process is designed to facilitate constructive patient engagement, taking a naturally complex set of symptoms and problems and organizing it for efficient clinical decision support. In addition, M3 Clinician provides longitudinal tracking to help ensure that the care being given is leading to desired outcomes.

Better patient engagement and understanding is key to reducing readmissions. Below are four simple ways we can begin to reduce readmissions.

1. Communicate with patients
2. Follow up with patients
3. Seek causes of readmission
4. Make the most of technology

To add to the success of using technology, the 443-bed El Camino Hospital in Mountain View, California, has used predictive analytics and videoconferencing techniques to reduce readmissions by 25 percent, combining technology with a personal touch. Technology, analytics and patient engagement is the key to reducing hospital readmissions. Focusing in these areas would reduce readmissions significantly and improve the quality of care, thereby benefitting the whole system.