Facing stiff penalties for high rates of readmissions — not to mention the overall drive to improve quality of patient care — many hospitals are exploring ways to assess a patient's likelihood of readmission and then take preventive action before a readmission can occur.
For several years, some hospitals have been dabbling in the use of a patient activation measure to gauge each health care consumer's level of involvement in his or her care. Developed at the University of Oregon, the tool uses a series of questions to assess patients' knowledge, skills and confidence in their ability to manage personal health.
A recent study found that patients with the lowest level of activation had almost twice the risk of returning to the hospital as their highest activated counterparts, and Judith Hibbard, a co-author and one of the inventors of the measure, thinks hospital leaders should take notice.
"Patient engagement is such a hot topic right now because we're all just recognizing that we aren't going to achieve better outcomes and lower costs unless patients are part of this, and they're able to do their part. So, figuring out how to help them do their part is what we need to do," Hibbard says.
Researchers from both Oregon and the Boston University School of Medicine analyzed data from some 700 adult patients who visited Boston Medical Center during a two-year period ending in October 2010. They found that those with the lowest patient activation were about 1.75 times more likely to return to the hospital within 30 days of discharge compared to the most activated patients. Contrary to popular belief, patients with lower activation did not tend to come from any specific racial, economic or educational population.
Knowing activation is helpful, but hospitals must use such data to try and target specific interventions to keep these patients from coming back, says Suzanne Mitchell, M.D., a family physician at Boston University Medical Center and author of the study. The Centers for Medicare & Medicaid Services estimate that 20 percent of Medicare patients re-enter the hospital within 30 days, costing some $2.6 billion annually. Meanwhile, the Medicare Payment Advisory Commission estimates that as much as 75 percent of 30-day readmissions might be preventable.
"The big black box is: How do we get there?' " Mitchell says.
In Boston's research effort called Project RED (Re-Engineered Discharge), some hospitals have been able to drop readmissions by as much as 40 percent through the use of such strategies as patient education, organizing post-discharge services and confirming the medication plan.
Last year, CMS penalized more than 2,000 hospitals a total of $227 million for high readmission rates. The penalty program started in October 2012. The patient activation measure could be the elixir that leaders are looking for, says Mary Jo Muscalino, R.N., a case manager for the Monroe Plan, which oversees some 160,000 lives in Rochester, N.Y., for Excellus BlueCross BlueShield, who has used the measure for the past two years.
"Everyone is looking for some kind of magic potion or process that will help people become more aware of the kinds of behaviors that they partake in that are detrimental to their health, and things that will improve it," she says.