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