Read­mis­sion rate among two new cri­te­ria used to de­ter­mine the Thom­son Reuters an­nual 100 top hos­pi­tals list

Modern Healthcare - - Editorial -

Read­mis­sion rates added to mix of 100 top hos­pi­tals cri­te­ria

Re­duc­ing pa­tients’ risk of un­nec­es­sary read­mis­sion to the hospi­tal af­ter dis­charge is a lot like un­tan­gling the spaghetti of wires tucked be­hind most peo­ple’s tele­vi­sion/sound sys­tems.

At least that has been the ex­pe­ri­ence at Rush Uni­ver­sity Med­i­cal Cen­ter in Chicago. “I think what we are see­ing, at least at our in­sti­tu­tion, is dis­ease com­plex­ity and so­cial com­plex­ity,” says David Ansell, vice pres­i­dent of clin­i­cal af­fairs and chief med­i­cal of­fi­cer at Rush.

For ex­am­ple, many of Rush’s pa­tients con­tend with mul­ti­ple dis­eases and with frag­ile so­cio-de­mo­graphic sit­u­a­tions, such as liv­ing alone or without emo­tional sup­port.

In an ef­fort to help pa­tients cope af­ter dis­charge, 681-bed Rush launched a pi­lot project in 2007 in which so­cial work­ers fol­lowed up via tele­phone with pa­tients at high risk of be­ing read­mit­ted. Pa­tients were deemed at risk if they were 65-plus years of age, took seven or more med­i­ca­tions, were dis­charged to their home, and had other com­pli­cat­ing fac­tors, such as liv­ing alone.

Of the 1,248 pa­tients called, 60% had un­re­solved is­sues—such as con­fu­sion about med­i­ca­tions—that took an av­er­age of 3.5 tele­phone calls over 4.5 days to ad­dress.

Rush isn’t the only in­sti­tu­tion fo­cused on re­duc­ing read­mis­sions, of course. The in­dus­try is be­ing pushed, in part, by the CMS, which pub­lishes 30-day read­mis­sion data on the Hospi­tal Com­pare Web site. In ad­di­tion, the re­form bill signed into law by Pres­i­dent Barack Obama last week in­cludes a pro­vi­sion to cut re­im­burse­ment to hos­pi­tals for cer­tain types of un­nec­es­sary read­mis­sions.

Thom­son Reuters re­sponded to the fo­cus on post-hospi­tal met­rics this year in its 17th an­nual 100 Top Hos­pi­tals: Na­tional Bench­marks study for 2009, which it re­leased ex­clu­sively to Mod­ern Health­care. Thom­son Reuters added mea­sures for both 30-day read­mis­sion and 30-day mor­tal­ity rates.

“We see this as where new best prac­tices are go­ing to de­velop that will change the de­liv­ery of health­care for the bet­ter,” says Jean Chenoweth, se­nior vice pres­i­dent of per­for­mance im­prove­ment and the 100 top hos­pi­tals pro­grams at Thom­son Reuters.

In ad­di­tion to 30-day read­mis­sion and mor­tal­ity rates, eight other mea­sures eval­u­ated pa­tient safety, clin­i­cal qual­ity, op­er­a­tional ef­fi­ciency, fi­nan­cial per­for­mance and pa­tient sat­is­fac­tion.

Rush, which made the list for the first time, was among 31 new­com­ers to the list.

NorthShore Uni­ver­sity Health­Sys­tem in Evanston, Ill., has been on the list the most fre­quently—14 years. Two hos­pi­tals have ap­peared on the list 12 times: 579-bed Ad­vo­cate Lutheran Gen­eral Hospi­tal in Park Ridge, Ill., and 391-bed Mun­son Med­i­cal Cen­ter in Tra­verse City, Mich. Van­der­bilt Uni­ver­sity Med­i­cal Cen­ter in Nashville, which has 833 beds, has made the list 11 times.

How they were cho­sen

To se­lect the 100 top hos­pi­tals, or bench­mark in­sti­tu­tions, hos­pi­tals with at least 25 beds were scored against oth­ers within the same cat­e­gory: Ma­jor teach­ing hos­pi­tals (400 or more beds and high lev­els of physi­cian ed­u­ca­tion and re­search); teach­ing hos­pi­tals (200 or more beds and some physi­cian ed­u­ca­tion) and three tiers of com­mu­nity hos­pi­tals: large (250 or more beds), medium-size (100-249 beds) and small (25-99 beds). A to­tal of 2,926 hos­pi­tals were in­cluded in this year’s study.

Hos­pi­tals in the top 100 must score well as com­pared with oth­ers in their size/teach­ing-sta­tus cat­e­gory, based on a com­pos­ite score of the 10 mea­sures. The 100 top hos­pi­tals also must score at least at the me­dian level of per­for­mance on each of the 10 mea­sures

Dou­glas Klein re­ceives aqua­phere­sis treat­ment at St. Thomas Hospi­tal in Nashville. The me­chan­i­cal process re­moves ex­cess flu­ids from pa­tients who don’t re­spond to di­uret­ics.

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