Hospi­tal mak­ing you ill?

Stress, anx­i­ety from stay could lead back to ER

Modern Healthcare - - THE WEEK IN HEALTHCARE - Mau­reen Mckinney

The stress, lost sleep, missed meals and anx­i­ety as­so­ci­ated with a hospi­tal stay take their toll on pa­tients’ health. But hos­pi­tals rarely deal with the cu­mu­la­tive im­pact of those per­sonal stres­sors, which in­crease the risk of pa­tients wind­ing up back in the hospi­tal, said Dr. Har­lan Krumholz of the Yale Univer­sity School of Medicine, New Haven, Conn. He coined the phrase “posthos­pi­tal syn­drome” in a re­cent New Eng­land Jour­nal of Medicine ar­ti­cle to de­scribe the dan­ger­ous pe­riod of cog­ni­tive im­pair­ment, re­duced phys­i­cal func­tion and emo­tional stress that of­ten fol­lows a hospi­tal stay.

“We tend to think of th­ese things—fear, sleep de­pri­va­tion, not get­ting around as much as we should—as just in­con­ve­niences that are part of be­ing in the hospi­tal. But in the ag­gre­gate, they can have a very pow­er­ful im­pact,” he said in an in­ter­view.

Post-hospi­tal syn­drome il­lus­trates the folly of look­ing too closely at one con­di­tion and my­opi­cally try­ing to pre­vent fu­ture re­lated com­pli­ca­tions, Krumholz said. The fed­eral government’s read­mis­sions re­duc­tion pro­gram, how­ever, re­lies on that frame­work.

Launched in Oc­to­ber 2012, the CMS’ read­mis­sion in­cen­tives pro­gram pe­nal­izes hos­pi­tals with higher-than-ex­pected rates of read­mis­sions for heart fail­ure, heart at­tack and pneu­mo­nia. A bet­ter way, Krumholz wrote in the ar­ti­cle, is to move away from “dis­pro­por­tion­ate at­ten­tion to the hos­pi­tal­iza­tion’s cause” and move to­ward a gen­eral ap­proach of height­ened aware­ness and at­ten­tion to pa­tients’ over­all health and well­ness af­ter dis­charge.

Yale re­searchers crafted the mea­sures that cur­rently make up the CMS’ read­mis­sions pro­gram, and Krumholz said he felt a par­tic­u­lar re­spon­si­bil­ity to make sure the ini­tia­tive is suc­cess­ful. “One thing that really might be im­ped­ing our progress is our fail­ure to take the whole pa­tient into ac­count,” he said.

Krumholz and his col­leagues have

fol­lowed up the orig­i­nal mea­sures with an all-cause read­mis­sions mea­sure, which was en­dorsed by the Na­tional Qual­ity Fo­rum. He said it could more ac­cu­rately cap­ture the many causes that land peo­ple back in the hospi­tal.

Hospi­tal ad­min­is­tra­tors need to rec­og­nize the im­pli­ca­tions of the syn­drome and ad­vise pa­tients of them, Krumholz said. “They should be told, ‘You are be­ing dis­charged but you are not well yet,’ ” he said. “‘Your judg­ment might be off, you may not want to drive, you may need help get­ting around.’ ”

Dr. Eric Cole­man, a ge­ri­a­tri­cian and head of the di­vi­sion of health­care pol­icy and re­search at the Univer­sity of Colorado, Aurora, and a well­known ex­pert on tran­si­tions of care, en­dorsed the ap­proach and praised Krumholz for call­ing at­ten­tion to the wide-rang­ing ef­fects that hos­pi­tal­iza­tion can have on pa­tients. The phe­nom­e­non has been wellestab­lished in the field of ge­ri­atrics for decades, he pointed out.

De­spite the lim­i­ta­tions of the CMS’ pro­gram, hos­pi­tals can still move the nee­dle on read­mis­sions, Cole­man said, by em­pha­siz­ing health lit­er­acy, pa­tient ac­ti­va­tion and the involvement of fam­ily care­givers. “Hos­pi­tals that have be­gun to look be­yond the nar­row three or four di­ag­noses are the ones mak­ing real progress,” he said.

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