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23-01-2013 | Article

Elderly care transitions demand all hands to the pumps

Abstract

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medwireNews: Community interventions coordinated by Medicare Quality Improvement Organizations (QIOs) have managed to nearly halve the number of hospitalizations and rehospitalizations among Medicare patients, according to a study in JAMA.

Through a more holistic, community-based approach to improve care transitions, such as switching a patient's care setting from a hospital to their home, rehospitalizations for Medicare patients have dropped by 5.7% in 14 communities taking part in the program.

It has been recognized that costly readmission of Medicare patients within 30 days is not solely a hospital issue - despite being hospitals taking the hit through penalties for high readmission rates. The Centers for Medicare and Medicaid (CMS) consequently asked QIOs to develop community coalitions to "do whatever it took to reduce readmission experience of all fee-for-service beneficiaries who lived there," explained lead author of the study, Jane Brock (Colorado Foundation for Medical Care) at a press conference. "It was a population focused initiative from the very beginning."

QIOs supported various types of providers by providing readmission incident data, technical assistance, and appropriate expertise depending on the specific needs of a community.

Altogether, the general strategies that proved effective involved ensuring better overlap between disparate coalitions, standardizing transition processes across local healthcare settings, efficiently transferring clinical information between providers, and actively engaging patients in their transitions.

Surprisingly, Medicare beneficiaries also experienced a 5.7% reduction in hospitalizations during the 2 years (2009-2010) of community interventions. Fifty comparison communities without intervention had only a 2.1% reduction in rehospitalizations and a 3.2% decline in hospitalizations over the same period.

Altogether, researchers figured that the interventions within the 14 communities studied added up to 6800 hospitalizations and 1800 rehospitalizations averted per year. The project as a whole would have saved Medicare $ 4 million per year in hospitalizations costs for every $ 1 million it cost to implement.

"One of the keys things that we think is so important about this is the demonstration that convening a bunch of providers - not just medical service providers - to really address the entire continuum of care that elderly people need at the time they are discharged from the hospital… can be effective quickly," Brock observed. "A bunch of providers trying to function in concert on behalf of the population they already mutually serve… is the key to intervention that explains our success."

By Peter Sergo, medwireNews Reporter