Table 2.
Hospital Readmission Reduction Programs
| Hospital Type | Health System |
|||
|---|---|---|---|---|
| U.S. Northeast |
U.S. Midwest Academic | U.S. South Academic | ||
| Community Teaching | Academic | |||
| Characteristics | 200+ beds, 15,000 admissions | 800+ beds, 32,000 admissions | 811 beds, 30,000 admissions | 1,150 beds; 49,000 admissions |
| Service | Single pulmonary service | Fellow based; multiple attendings | APN led | One NP |
| Care manager(s) | COPD dedicated CM inpatient/outpatient with close ties to pulmonary practice | Inpatient-specific general CMs | Multiple | Two RNs |
| Physician role | Standard pulmonary consult on all COPD admissions | Pulmonary champions care path development, but not routinely involved in individual patient care | Three physician champions (pulmonologist, hospitalist, pulmonary fellow) | Four COPD leads |
| Program type | QI | QI | QI | BPCI |
| Program elements | CM-led documentation of care plan, education assessment, PR, home visit | Care pathway–led program | APN-led inpatient consult, pharmacy-led medication reconciliation and inhaler education, RN 48 h phone call, APN follow-up visit, APN/MD 24/7 pager, EHR alert for ED visits | RN/NP inpatient consult |
| Real time score for General Health Readmission Risk tool | Medication reconciliation | |||
| Follow-up pulmonary visit | ||||
| Automated and in person post-D/C calls | ||||
| Referral to PR, palliative care, home health, electronic order set | ||||
| System to identify inpatients with AECOPD | N | N | Y | Y |
| Inpatient consult | Single pulmonary service; all seen | Fellow-based | Y—APN | Y—RN or NP |
| Care plan documentation | Y—CM | Y—Routine Hospital D/C | Y—APN | Y—powerplan |
| Education assessment/teaching | Y—CM | Y—Routine Hospital D/C | Y—APN and pharmacists | Y RN or NP |
| RH assessment/referral | Y—CM | N | Y—APN | Y |
| Medication reconciliation | Y—Routine Hospital D/C | Y—Routine Hospital D/C | Y—pharmacists | Y—pharmacists |
| Post-D/C home visit | Y—CM | N—except those qualifying for home VNA | N | N |
| Post-D/C phone call | Y | N—not routine | Y—RN | Y—automated and person–person |
| Post-D/C clinic visit | Y—1–2 wk | Y—pathway recommended 1–2 wk | Y—APN +/− pharmacists 1–2 wk | Y—COPD Clinic, 1–2 wk |
| EHR alert | Y—ED | Y | ||
| Risk score | N | Y | N | Y |
| Direct patient call line/number | Y | Y—health plan based | Y—APN/MD pager | Y |
| Order set/pathway | Y | Y | ||
| Process measures | ALL | <20% utilization of pathway | Improved identification of patients with AECOPD 64–84% | Improved identification of patients with AECOPD 45–85%; improved PR from 5 to <20%; 0–100% phone calls |
| Readmissions | 37% reduction | 27% reduction | 46% reduction | NS |
| Patient feedback | Patients liked program, did not want to be “discharged” from program | |||
| Other info | Site created after D/C trajectory tool being tested in patient subset | Asthma DRG included in BPCI | ||
Definition of abbreviations: AECOPD = acute exacerbations of chronic obstructive pulmonary disease; APN = advanced practice nurse; BPCI = bundled payments for care improvement; CM = case/care manager; COPD = chronic obstructive pulmonary disease; D/C = discharge; DRG = diagnosis-related group; ED = emergency department; EHR = electronic health record; MD = medical doctor; N = no; NP = nurse practitioner; NS = nonsignificant; PR = pulmonary rehabilitation; QI = quality improvement; RN = registered nurse; VNA = visiting Nurse Association; Y = yes.