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How to keep patients from returning to the hospital

July 25, 2011

When someone goes to the hospital, the ideal situation is they eventually get better and leave. But all too often (around 20 to 25% of the time) patients return within 30 days  for reasons similar to the first time they needed hospital care.

Experts point to various reasons why this might happen- hospitals rushing patients out the door before they’ve fully healed, patients failing to make the lifestyle changes necessary for a complete recovery, and a general lack of coordination between hospital and community care.

Quality Partners of Rhode Island is among the groups looking to cut those readmission rates down and in the process save money and keep patients healthy.

The group was just part of a small study testing the effectiveness of health coaches who call and visit patients at home after they leave the hospital.

The “quasi-experimental study” (it’s quasi experimental because not all of the study groups were randomized) based on data from Rhode Island patients  is  in the most recent issue of the Archives of Internal Medicine and shows some initially positive results.

Of the 238 participants who received at least one home visit and one phone call from a health coach, 12.8% returned to the hospital within 30 days.  That’s less than the percentage of the 736 patients who didn’t receive coaching-18.6%, and much less than the percentage of the 14,514 patients not approached for the study-20%.

The study authors cautiously call this a victory, saying that the intervention-

…appears to be effective in this real world implementation. This finding underscores the opportunity to improve health care outcomes beginning at the time of discharge in open health care settings.

But the research does have some limitations.

  • The control group of patients that didn’t receive coaching were initially approached by researchers and either declined to participate or were unreachable for a follow up. That means the patients that received coaching both agreed to get advice and made themselves available to the researchers, the same people who might be more motivated to stay out of the hospital to begin with.
  • Researchers didn’t exclude surgical patients from the external control group and did exclude surgical patients from the coaching group. Folks who received surgery might be more vulnerable to readmissions.
  • The sample size was pretty small, only 8% of the total population of hospital patients, so it’s hard to conclude too much.

Regardless, the research is an interesting first step in what seems to be a pretty commonsense solution- help patients transition out of the hospital to keep them from coming back in.

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