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Study Evaluates Rehospitalizations and Hospitalizations For Medicare Beneficiaries Following Implementation of Quality Improvement Intervention for Care Transition

EMBARGOED FOR RELEASE: 3 P.M. (CT) TUESDAY, JANUARY 22, 2013

Media Advisory: To contact corresponding author Joanne Lynn, M.D., M.A., M.S., call Ken Schwartz at 571-733-5709 or email Ken.Schwartz@altarum.org. To contact editorial author Mark V. Williams, M.D., call Marla Paul at 312-503-8928 or email marla-paul@northwestern.edu.


CHICAGO – Communities in which quality improvement initiatives for care transitions were implemented for Medicare beneficiaries had declines in rates of all-cause 30 day rehospitalizations and all hospitalizations, but no significant reductions in the rates of all-cause 30-day rehospitalizations as a percentage of hospital discharges, according to a study appearing in the January 23/30 issue of JAMA.

“Many Medicare beneficiaries have serious illnesses and disabilities and receive services from multiple clinicians and health care settings, engendering risks of errors in transitions and rehospitalizations,” according to background information in the article. “The Centers for Medicare & Medicaid Services (CMS) piloted various strategies for improving care and reducing costs in 2006-2007, including one that tested having Quality Improvement Organizations (QIOs) lead improvements in care transitions. Medicare’s QIOs serve each state and territory, aiming to improve the value of services.”

Jane Brock, M.D., M.S.P.H., of the Colorado Foundation for Medical Care, Englewood, and colleagues conducted a study to evaluate whether QIO-facilitated community-wide quality improvement (QI) could improve care transitions for Medicare beneficiaries and whether this work would correlate with reduced rehospitalizations. The study included an analysis of performance differences for 14 intervention communities and 50 comparison communities from before (2006-2008) and during (2009-2010) implementation. Intervention communities had between 22,070 and 90,843 Medicare fee-for-service (FFS) beneficiaries. For the intervention, QIOs facilitated community-wide quality improvement activities to implement evidence-based improvements in care transitions by community organizing, technical assistance, and monitoring of participation, implementation, effectiveness, and adverse effects.

The researchers found that the 14 intervention communities had an average reduction of 5.70 percent in rehospitalizations per 1,000 and of 5.74 percent in hospitalizations per 1,000 for FFS Medicare beneficiaries over the 2-year intervention period, with progressive improvement throughout. “During the same period, the 50 comparison communities had smaller mean reductions in rehospitalizations (2.05 percent) and hospitalizations (3.17 percent). Process control charts confirmed signals of important changes with the onset of the intervention. However, the widely used measure of rehospitalizations as a percentage of hospital discharges did not change during the study period, with a difference of 0.06 percent in the intervention communities and a difference of -0.16 percent in the comparison communities. The diversion to other Medicare-covered services was small, and mortality and patient-reported quality either did not change or improved.”

“This CMS QIO initiative demonstrated that Medicare beneficiaries in communities in which QI initiatives were implemented to promote evidence-based care transitions, compared with Medicare patients in communities without this QI implementation, had lower all-cause 30-day rehospitalization rates per 1,000 and all-cause hospitalization rates per 1,000 but no significant reductions in the rates of all-cause 30-day rehospitalizations as a percentage of hospital discharges,” the authors write.

(JAMA. 2013;309(4):381-391; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor’s Note: This project was funded through the CMS. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

 

Editorial: A Requirement to Reduce Readmissions – Take Care of the Patient, Not Just the Disease

Mark V. Williams, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, comments on the three studies in this issue of JAMA that examine acute care, rehospitalization, and care transition among adult patients.

“The findings from these 3 reports also illustrate what experienced hospitalists, emergency physicians, and perhaps other physicians clearly recognize—the increasing fragmentation of patient care and consequent inappropriate use. Lack of coordinated care transitions has affected patients in the United States for half a century, but individual patients now see an increasing number of physicians, increasing the possibility of medical error, duplication of services, reduced quality, and increased cost. This has likely been driven, at least in part, by the marked expansion in the number of subspecialists, who now outnumber primary care physicians by about 2 to l. Medicare beneficiaries and their families must navigate seeing a median [midpoint] of 2 primary care physicians and 5 specialists during a 2-year period, and about one-third change their assigned physician from one year to another. This fragmentation escalates as patients approach the end of their lives with numerous physicians involved in a patient’s care.”

(JAMA. 2013;309(4):396-398; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor’s Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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