Quality collaboratives and campaigns to reduce readmissions: What strategies are hospitals using?

Authors

  • Elizabeth H. Bradley PhD,

    1. Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    2. Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
    Search for more papers by this author
  • Heather Sipsma PhD,

    1. Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    Search for more papers by this author
  • Leslie Curry PhD,

    1. Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    2. Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
    Search for more papers by this author
  • Devi Mehrotra BS,

    1. Yale College, Yale University, New Haven, Connecticut
    Search for more papers by this author
  • Leora I. Horwitz MD,

    1. Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
    2. Department of Medicine, Yale School of Medicine, New Haven, Connecticut
    Search for more papers by this author
  • Harlan Krumholz MD, SM

    Corresponding author
    1. Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    2. Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
    3. Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
    4. Department of Medicine, Yale School of Medicine, New Haven, Connecticut
    • Address for correspondence and reprint requests: Elizabeth H. Bradley, PhD, Professor of Public Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520; Telephone: 203-499-7351; Fax: 203-785-6287; E-mail: Elizabeth.Bradley@yale.edu

    Search for more papers by this author

Abstract

BACKGROUND

Reducing hospital readmissions is a national priority, and many hospitals are participating in quality collaboratives or campaigns.

OBJECTIVE

To describe and compare the current use of hospital strategies to reduce readmissions in 2 prominent quality initiatives—STAAR (State Action on Avoidable Rehospitalization) and H2H (Hospital-to-Home Campaign).

DESIGN

Cross-sectional.

METHODS

Web-based survey of hospitals that had enrolled in H2H or STAAR from May 2009 through June 2010, conducted from November 1, 2010 through June 30, 2011 (n = 599, response rate of 91%). We used standard frequency analysis and multivariable logistic regression to describe differences between STAAR and H2H hospitals.

RESULTS

Many hospitals were not implementing several of the recommended strategies. Although STAAR hospitals tended to be more likely to implement several strategies, differences were attenuated when we adjusted for region and ownership type. In multivariable models, STAAR hospitals compared with H2H hospitals were more likely to ensure outpatient physicians were alerted within 48 hours of patient discharge (63% vs 38%, P < 0.001), and more likely to provide skilled nursing facilities the direct contact number of the inpatient treating physician for patients transferred (53% vs 34%, P = 0.001). H2H hospitals were more likely to assign responsibility for medication reconciliation to nurses usually or always (80% vs 54%, P = 0.001) and more likely to give most or all discharged patients referrals to cardiac rehabilitation services (59% vs 41%, P = 0.001).

CONCLUSIONS

Substantial opportunity for improvement exists for hospitals engaged in STAAR or H2H quality initiatives. Journal of Hospital Medicine 2013;8:601–608. © 2013 Society of Hospital Medicine

Ancillary