A couple of recent studies of patients from opposite ends of the age spectrum point to ways in which hospitals can team up with other providers to improve care and rein in health care spending. The findings underscore the new imperative for hospitals to build a strong continuum of care in their communities to prevent avoidable hospitalizations. That will become a critical element in future reimbursement formulas.

One study of 20,000 children enrolled at Group Health Cooperative found that young kids who miss more than half their recommended well-child visits have twice the risk of hospitalization as those who attend most of their visits. The numbers are even worse for children with chronic conditions: those who miss more than half their recommended well-child visits have more than three times the risk of hospitalization than chronically ill kids who attend most of their visits.

"Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider," says lead author Jeffrey Tom, M.D., an assistant investigator with the Kaiser Permanente Center for Health Research in Hawaii. "These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital." When he conducted the study, Tom was a senior fellow in the University of Washington Department of Pediatrics.

The results might be even more worrisome if a similar study were to be conducted at other health care organizations; this research took place in an integrated health care system in which well-child visits are typically well-attended and the children tend to come from families with above-average incomes and education.

Another study by Tufts Medical Center in Boston and the Alzheimer’s Drug Discovery Foundation shows that Medicare patients with Alzheimer’s disease and related disorders are hospitalized more frequently for potentially avoidable illnesses and require longer lengths of stay than many other patients. That leads to higher costs and increased risk of infection and adverse events.

The good news is that "complications related to conditions such as diabetes, hypertension and heart failure are potentially avoidable through high-quality outpatient management and care," says Pei-Jung Lin, lead investigator on the study and an assistant professor at Tufts University School of Medicine. The researchers recommend complex care management, which includes care managers who are empowered to coordinate care and clinical interventions, improved and speedy discharge planning, and robust follow-up care.
 
Both studies pose the same question for hospitals: how to work with their own staffs, and with physicians and other members of the community support system to make sure whatever care is needed is readily accessible, that patients and families understand their health issues and recommended care, and that patients who are unable to monitor their own care get all the help they need.

That would go a long way to strengthen your continuum of care, and your community.