Introduction
Readmission entails a certain incident where a patient is admitted again within a defined period of time after discharge from the hospital. One key indicator of this outcome is readmission rates. Such an indicator is instrumental in measuring the quality and effectiveness of services in the health system. Australia is among the countries where such readmission cases are high because of reasons such as the lack of synchronized transitional care strategy among others (Diplock et al. 2017).
As presented in this proposal, although some health systems in Australia may be recording low readmission rates, cases have been observed in others where such levels are high as revealed in a study by Basu, Avila, and Ricciardi (2016). Can addressing the main causes of high readmission rates in Australia and the establishment of relevant mechanisms to improve this outcome make the country one of the healthiest globally by 2020? This project proposal seeks to investigate this question based on the findings of particular health systems in Australia. It will also recommend various strategies that can be employed to improve this essential health service outcome in various health systems within and outside this country.
Literature Review
Hospital readmissions are a common occurrence in the current Australian health system. Sadly, readmissions come with the baggage of higher costs of healthcare for patients, insurance companies, and healthcare programs. Bradley et al. (2012) highlighted that high readmission rates in the US cost Medicare an estimated more than 17 billion US dollars annually because of hospital payments. The costs included emergency care, surgical care, primary care, consultation fees, examination fees, lab tests, and bed fees. Fortunately, according to Joynt and Jha (2012) and Diplock et al. (2017), this outcome can be improved since a significant fraction of these readmissions is preventable through plans such as the establishment of a synchronized transitional care strategy among others.
One of the causes of high admission rates in hospitals is poor patient engagement. According to Hibbard and Greene (2013), patient engagement is a pertinent component in reducing readmissions to hospitals. The strategy entails instilling the necessary knowledge, skills, and confidence to patients in a manner that they are actively engaged in their health care. A study carried out by Peter et al. (2015) presented patient engagement through education as an essential tool that can reduce incidences of readmissions. Therefore, it should be incorporated as part of post-discharge counseling to help clinicians in comprehending areas that patients may require reinforcement of information on their condition and consequently reduce the risk of readmission resulting from poor self-care.
To measure this outcome, Rademakers et al. (2012) suggested that hospitals could formulate a Patient Activation Measure sheet to be filled by the patient before discharge. This instrument assesses the level of knowledge, skills, and confidence in self-care and management by patients for their condition. Thus, before discharge, clinicians stand a chance to ensure that patients can take care of themselves while at home, thus reducing the risk of readmission due to poor quality self-management.
Another major cause of the high number of admissions is the poor follow up of patients after discharge. Lee et al. (2016) carried out a quantitative case study to investigate the correlation between post-discharge characteristics and 30-day readmissions for heart failure patients in a large healthcare system in California. From the results, the study recommended the need for hospitals to formulate systematic in-door policies for follow up after discharge to reduce the risk of readmission. The recommendation is founded on the claim that clinical concerns can be discovered and managed early, thus avoiding their progression to warrant readmission. Therefore, by carrying out similar studies within hospitals in Australia, clinicians can obtain and measure the outcomes of effective follow-up strategies and seal loopholes that can jeopardize the process.
Another cause resulting in high rates of readmission in Australia is the lack or poor implementation of transitional care intervention after discharge (Diplock et al. 2017). A similar study carried out by Feltner et al. (2014) denoted that organizing home visits by clinicians, nursing practitioners, or pharmacists to educate, reinforce instructions on self-management, perform a routine examination, and/or provide other primary follow-up care could help to reduce the rate of readmissions.
Additionally, the study highlighted home care visits as the most effective transitional care interventions compared to other mechanisms such as telephone monitoring, primary education, individual peer support, and outpatient clinic-based strategies. As a result, Australian hospitals or departments that record-high rates of readmission should adopt the strategy, which is expected to be efficient, irrespective of the patients’ geographical location within Australia. The outcome should be measured by determining the number of readmissions for persons who receive home visits.
Poor communication between outpatient and inpatient physicians has been regarded as a cause of the high rate of readmission in health systems. One of the core reasons for readmissions due to poor communication has been adverse events (Kociol et al. 2012). Thus, improvement of this process would inevitably reduce the cases of severe adverse events and resultantly improve the outcome of readmissions. To dig further on this hypothesis, a quantitative study by Kociol et al. (2012) was carried out by administering a survey on staff in the cardiology departments of a hundred randomly selected institutions.
From the findings, the study revealed that 89% of the hospitals carried out steps to inform the patients’ primary care provider at outpatient facilities after discharge. A separate study by Volk et al. (2012) also suggested that a structured discharge summary report should be prepared before discharge as it has been associated with better and more effective communication between inpatient and outpatient clinicians. One of the key measurement indicators of this outcome would be the number of readmissions that result from adverse events.
The Choice of this Outcome
Readmissions are a common measure of health service outcomes across the world. Furthermore, they are costly to both public and private healthcare programs. Thus, information on this contingent subject can help to mitigate health care costs not only in Australia but also everywhere around the globe. Hence, the study finds it crucial to explore the various strategies that have been successfully applied by health systems to reduce the rate of hospital readmissions to save on costs. To measure this outcome, the study will quantify financial and clinical data that reflects the number of readmissions in the selected health systems. The study will also include a balanced measure of how readmission affects other health outcomes such as mortality and patient experience, including the effectiveness, timeliness, and safety of care.
Study Design and Analysis
The paper will adopt a quantitative retrospective study design using the existing patients’ records in the last year. The records will be obtained from 10 randomly selected hospitals in the US. Dependent variables to be used to measure this outcome will include the number of patients readmitted with and without scheduled follow-ups, with and without home physician visitations due to adverse events, and/or with and without active participation in self-management.
The study design will help to establish the costs incurred by patients in their subsequent readmission from which the average and total costs will be determined and grouped according to the condition. Findings from this study will reveal how hospital readmissions affect patient experiences, mortality, the efficacy, relevance, and safety of care for other patients already admitted.
Ethical Conduct
For the study to be carried out smoothly in line with the laid down protocols, the investigator will formally seek permission from the respective hospital authorities. Ethical conduct also requires sensitive patient information to be kept confidential. Thus, it will not be disclosed to unauthorized personnel. Questionnaires to be filled by hospital personnel will also need approval by ethics committees from all ten hospitals before being used for the study. Any adjustments recommended by the ethics board will be made and the final draft of questionnaires issued to committees for final approval.
Conclusion
Australia is among the countries in the world that are striving to attain the lowest patient readmission levels by 2020. Based on the expositions made in this study, it will be vital for Australia to not only address the root of the reportedly high rates of readmission but also put in place mechanisms to enhance the outcome if it wishes to be ranked among the healthiest countries by 2020.
Reference List
Basu, J, Avila, R & Ricciardi, R 2016, ‘Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?’, Health Services Research, vol. 51, no. 3, pp. 1135-1135.
Bradley, E, Curry, L, Horwitz, L, Sipsma, H, Thompson, J, Elma, M, Walsh, M & Krumholz, H 2012, ‘Contemporary evidence about hospital strategies for reducing 30-day readmissions: a national study’, Journal of the American College of Cardiology, vol. 60, no. 7, pp. 607-614.
Diplock, G, Ward, J, Stewart, S, Scuffham, P, Stewart, P, Reeve, C, Davidson, L & Maguire, G 2017, ‘The Alice Springs Hospital readmission prevention project (ASHRAPP): a randomized control trial’, BMC Health Services Research, vol. 17, no. 1, pp. 1-11.
Feltner, C, Jones, C, Cené, C, Zheng, Z, Sueta, C, Coker-Schwimmer, E, Arvanitis, M, Lohr, K, Middleton, J & Jonas, D 2014, ‘Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis transitional care for persons with heart failure’, Annals of Internal Medicine, vol. 160, no. 11, pp.774-784.
Hibbard, J & Greene, J 2013, ‘What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs’, Health Affairs, vol. 32, no. 2, pp. 207-214.
Joynt, K & Jha, A 2012, ‘Thirty-day readmissions—truth and consequences’, New England Journal of Medicine, vol. 366, no.15, pp.1366-1369.
Kociol, R, Peterson, E, Hammill, B, Flynn, K, Heidenreich, P, Piña, I, Lytle, B, Albert, N, Curtis, L, Fonarow, G & Hernandez, A 2012, ‘National survey of hospital strategies to reduce heart failure readmissions: findings from the ‘get with the guidelines-heart failure’ registry’, Circulation: Heart Failure, vol. 5, no. 6, pp. 680-687.
Lee, K, Yang, J, Hernandez, A, Steimle, A & Go, A 2016, ‘Post-discharge follow-up characteristics associated with 30-day readmission after heart failure hospitalization’, Medical Care, vol. 54, no. 4, pp. 365-372.
Peter, D, Robinson, P, Jordan, M, Lawrence, S, Casey, K & Salas-Lopez, D 2015, ‘Reducing readmissions using teach-back: enhancing patient and family education’, Journal of Nursing Administration, vol. 45, no. 1, pp. 35-42.
Rademakers, J, Nijman, J, van der Hoek, L, Heijmans, M & Rijken, M 2012, ‘Measuring patient activation in the Netherlands: translation and validation of the American short form patient activation measure (PAM13)’, BMC Public Health, vol. 12, no. 1, pp. 577-577.
Volk, M, Tocco, R, Bazick, J, Rakoski, M & Lok, A 2012, ‘Hospital re-admissions among patients with decompensated cirrhosis’, The American Journal of Gastroenterology, vol. 107, no. 2, pp. 247.