Improving transitions to reduce readmissions.

摘要: SUMMARY Delivering high quality healthcare requires crucial contributions from many parts of the care continuum. However, as becomes increasingly specialized, coordination between providers and settings is too often not conducted a team effort. In hospital setting, poor results in readmissions, which are avoidable. this article, we describe processes that hospitals can implement immediately to dramatically improve transitions reduce re-hospitalization rates. Readmission rates focus interest for payers policymakers seeking promote efficiency quality. Hospital executives may want prepare their organization excel on performance metric anticipation payment, policy, and/or other forecasted changes market. recent conversation with chief medical officer at large health system United States, physician executive relayed stories about his own hospitalization an emergency surgical procedure. He was mostly delighted he received, but, when asked if had experienced any surprises, responded way: "The pain surprise-mostly because each nurse seemed have or her theory management. Some predicted managed aggressively, others 'followed orders' letter, even I severe pain, without consulting surgeon. The biggest surprise home. alone, fearful, uninformed, disconnected. no real education how myself way reach out information, guidance, consolation, care. thought maybe it am physician, but now sensitive this, see failure happening everywhere." December 2000 speech, Don Berwick, president CEO Institute Healthcare Improvement, labeled "discharge" dirty word-associated generally unpleasant ideas images. A majority patients discharged fail receive basic necessary planning preparation. One study found 81 percent requiring assistance functional needs failed home referral, 65 said one talked them managing home.1 These gaps lead readmission surprisingly number cases. costs associated consume nearly onethird total dollars spent States.2 body experience evidence suggests that, among population individuals who hospitalized re-hospitalized frequency, hospitalizations avoidable.3 Our by improving transitions, achieve lower will outline broad categories failures Improvement's (IHI) approach reducing 30-day rates, our coaching teams working re-hospitalizations. We believe executives-through direct influence institutional procedures processes-can significant WHY FOCUS ON READMISSION RATES? Readmissions represent, some cases, defect hospitals' processes, ambulatory support system, community. By focusing improvement effort different settings, leaders they provide patients. increasing cost prompting purchasers scrutiny high-cost areas yield low Attention heightened current economic climate, search potential savings priority. Therefore, fiscal reasons attention executives, payers, policymakers. …