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BSN FP4014 Global Perspectives of Community and Public Service

Analyzing Hospital Readmission as One of Health Issues Affecting United States

                                                                Introduction

Unnecessary hospital readmission has become a major concern to all healthcare stakeholders and policy makers in the United States over the recent years.  In America, the associated cost of hospital readmission is estimated to be more than $39 billion per financial year (Diana et al, 2014).  In a move to reduce this cost, policy makers have been prompted to enact policies such as The Affordable Care Act (ACA) that penalize hospitals for readmission cases witnessed within 30 days after the first admission (Cloonan, Wood and Riley, 2013).  In particular, health facilities have experienced a reduction in Medicare financing in cases where certain patients are readmitted to the hospital within thirty days of discharge.  In addition, enacting reforms in delivery and payment systems like accountable care organization and bundled payments are aimed at enhancing the transition of patient to post-acute setting from the acute care.  This helps in reducing the number of hospital readmission cases.  Reducing the rate of hospital readmission has been identified as one of the mechanisms to reduce the cost of Medicare and providing improved patient care.

In the past, the focus has been on the payment reforms as a mechanism to reduce cases of avoidable hospital readmission.  However, between 2012 and 2013, research was performed in United States to investigate the major causes of hospital readmission. The main objective of the research was to investigate whether the readmission cases were preventable as well as investigating the major causes of hospital readmission.  The researchers also identified an evidence-based approach to reduce the problem.

Factors That Contribute to High Cases of Hospital Readmission

Through numerous studies, various causes of hospital readmission have been identified.  To begin with, premature discharge from hospital has been identified as a major cause of hospital readmission.  Premature discharge entails discharge of patients before they are fully capable of taking care of their health condition.  This may arise due to miscommunication among the concerned practitioners while in other cases it may emanate from having transitional gaps.  Secondly, failure to communicate critical information to outpatient health care practitioners happen to be another cause of hospital readmission.  This is where the patients are under home-based health care where nurses are assigned to a specific patient and are treated in their homes.  In such cases, the coordination between the outpatient and inpatient health care providers is critical to minimizing the number of readmission cases through relaying relevant information about the patient.  A lack of proper discussion regarding the care goals among the patient suffering from serious illness is also highlighted to be a serious cause of hospital readmission.  Since the best health care practice requires collaborative health care provision, it is important that all stakeholders involved clearly understand the main goals of each patient’s medical program.  Clear goals ensure that all stakeholders are guided on the ultimate desired results, thereby promoting extensive and inclusive consultations (Jacques et al, 2013).  Lastly, failure by the Emergency Department to make the correct decision on the right patient to be treated as an inpatient or outpatient can often lead to unbalanced utilization of scarce hospital resources.

Interventions to Reduce Cases of Hospital Readmission

 One intervention to overcome this issue is improving patient education and engagement.  It is noted that regularly, patients, friends, and caregivers receive information that is conflicting, unclear (instruction), and inappropriate medication regimens.  Thus, patients may fail to understand their medical condition and the ultimate goal of the medication plan.  Healthcare providers improve patient engagement through patient education.  Strategies such as information teach back may be used to achieve this.  Secondly, the healthcare institutions should optimize efficient transitions of care.  Ineffective transition of care is a major contributor to hospital readmission.  In 2011, it was reported that the Medicare cost associated with inadequate care coordination amounted to between $25 and $45 billion.  In the recent years, hospitals have established a clinical entity assigned the responsibility of promoting and coordinating patient health care throughout the medical care facility and among the various health care providers.  Lastly, from the year 2012, with the The Affordable Care Act (ACA). The Act introduces a penalty for hospitals that record specific number of patient readmission within 30 days of initial discharge.

Role of Nurses and Healthcare Providers in Reducing Hospital Readmission

Health care practitioners and nurses play an important role as educators to help the patients to cope with the required lifestyle changes.  Post discharge education ensures that patients are able to understand their health conditions, their prescribed medication, and discern the appropriate time to seek medical treatment.  Nurses should therefore teach and assess the ability of patient to have self-care abilities such as checking fluid and sodium restrictions, medication use, weight control as well as monitoring deteriorating symptoms and signs associated with worsening of the disease.  As such, nurses should aim to discover the barricades that prevent patient from adhering to the recommended practices.  Understanding the challenges helps the nurses adopt strategies that would enable the patients overcome the obstacle.

Recommendation

The above discussion has identified the primary reasons that are associated with hospital readmissions in the United States.  The factors identified focused on the hospital systems such as premature discharge as well as patient financial status such as poverty as some of the reasons for hospital readmission.  It is recommended to support post-discharge services and understand comorbidities that often led to new complications leading to readmission.