"It's a Revolving Door," the Experts Say

 

 

The "revolving door" is what a recent report calls hospital readmissions -- the avoidable ones. The problem is an alarming one, it's costing the U.S. Medicare program billions of dollars, and perhaps worst of all, it's causing needless suffering in elderly patients.

Using new Medicare data from the Dartmouth Atlas Project, the report, published earlier this month by the Robert Wood Johnson Foundation, shows that in 2010 one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery. One in six were readmitted within 30 days of receiving medical care.

The numerous interviews conducted of patients and their families in an effort to find out why so many Medicare hospital patients are returning so quickly revealed some major themes.

Here a couple of stories featured in the report, The Revolving Door: A Report on U.S. Hospital Readmissions:

Eric left the hospital "dog-tired" after a bout of chronic obstructive pulmonary disease. He was given an inhaler but he had no idea how to use it. He continued to smoke. Not surprisingly, Eric was back in the hospital and given instruction on the use of his inhaler and a checklist on how to monitor his COPD. He began taking smoking cessation classes.

Barbara, who has type 2 diabetes, went to the emergency department because her blood sugar was out of control. She was stabilized and released to home. Shortly afterwards, she was back in the hospital with the same problem: this time, she was given instruction on how to self-administer insulin and eat right, meeting regularly with a dietitian. In the 14 years she had had diabetes, Barbara's primary care physician had never offered her that kind of help.

Indeed, the Dartmouth researchers found that of those Medicare patients readmitted within 30 days, two-thirds were due to some sort of medication event.

Tools for Patients (and their Families)
What to do? How can patients improve their hospital experience and minimize the likelihood of returning?

The Web site of the Robert Wood Johnson Foundation offers, free of charge, four Toolkits for download:

1. How to Avoid Being Readmitted. This fact sheet can help patients take steps to avoid  a return visit to the hospital. For example, patients are encouraged to become actively involved in their own discharge plan: when is my next appointment? What medications will I be taking, how do I take them, and why?

2. Discharge Checklist & Care Transition Plan. These are tools patients and their caregivers can use to keep track of their care plan after leaving the hospital.

3. Enabling Better Care Transitions. This resource shows how hospitals and communities are working to improve transitions from hospital to home and implementing a variety of interventions.

4. Ten Things You Should Know. These 10 facts from Care About Your Care show why care transitions are so critical and how costly the problem has become. For example, Medicare estimates that avoidable readmissions cost the program more than $17 billion a year.

To read more about the revolving door of hospital readmissions, visit the Robert Wood Johnson Foundation's Care About Your Care initiative Web site at http://www.careaboutyourcare.org.

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