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July 2005

Reducing Your Re-hospitalization Rates

The National Hospitalization Reduction Study, sponsored by Briggs Corporation and co-sponsored by the National Association for Home Care (NAHC) and Fazzi Associates will identify best practices for reducing unplanned hospitalizations and share the information with the field.

Now that Phase I is complete, we have entered into Phase II. We currently have over 320 agencies registered to participate in this study. Thanks to their willingness to participate and the openness of the many other top performing home care agencies, we are confident the insights gained from this effort will directly and positively impact the percentage of unplanned and preventable hospitalizations in this country.

Phase II was kicked off during the National Steering Committee’s survey design meeting. In preparation for this meeting, we invited any home care professional who had thoughts or ideas on what might reduce hospitalizations to make suggestions on a special web page survey developed specifically for this effort. Nearly 400 agencies throughout the country responded to the following question:

What practices, processes, strategies, etc. do you believe positively impact (reduce) unplanned or preventable hospitalizations of home care patients throughout the
United States?

What was fascinating about the responses was they tended to group around a number of major strategies or practices respondents believe (if used appropriately) would help agencies reduce the number of unplanned or preventable hospitalizations. Even more fascinating was that many of the top recommendations (four out of the first five) did not call for major outlays of money. Instead, they called for agencies to focus on improving their clinical practices as a preferred strategy for reducing unplanned or preventable hospitalizations. These categories provide agencies with insights into areas they may wish to focus on as they strive to improve their quality scores.

Using these suggestions, the National Steering Committee has identified the key areas to be explored in the survey. We are now in the process of developing the survey and disseminating it to participating agencies.

As always, we want to keep you as informed as possible as the study progresses. Please do not hesitate to contact us with any questions you
may have.

Listing of Major Responses:
These responses are presented in a prioritized manner, with the first item (Better Patient and Family Member Education) representing the most recommendations (50) from the field. The parenthesis at the end of each statement refers to the number of respondents who had listed the item.

A. Better Patient and Family Member Education: Provide patients and family members with better education on services and what to do and who to call in case of a "perceived" emergency.
(50)

B. Physician Relationships: Work closely with physicians. Develop more positive, mutually supportive relationships so physicians are better aware and supportive of your efforts.
(35)

C. Telehealth: Use telehealth for more patients and for specific diseases.
(32)

D. Strong, 24 Hour Immediate Response System: Have a response system that is proactive and responds quickly to emergencies.
(29)

E. Hospital and LTC: Work closely with those making discharges.
(28)

F. Disease Management Programs: Establish disease management programs for major diseases. (i.e. COPD, CHF, Asthma, Diabetes, Wounds, etc.).
(22)

G. Appropriate Team and Clinician Approach to Service Delivery: Use the right disciplines and a team model to approach service delivery.
(20)

H. Early Intensive Support: Provide more intensive services early in the process.
(19)

I. Medication Management: Improve medication management for patients.
(17)

J. OASIS/Clinical Assessment and Care Plan: Ensure you are doing an accurate assessment using the right tools and develop an optimal care plan. Identify patients at risk at the front of the service.
(17)

K. Telephone Calls Between Visits: Have on-going contact with patients at risk using phone calls between visits.
(13)

L. Caregivers in Home: Involve more. Support more.
(12)

M. Patient Behavior: Identify high risk patients and unique needs, and develop individual strategies to monitor and address the needs.
(10)

N. Continuity of Caregivers: Reduce the number of different professionals from the same discipline who provide services.
(6)

O. Fall Prevention: Establish a fall prevention program for
patients.
(4)

P. Quicker Referral to Hospice: Work more closely with Hospice Programs. Make referrals more quickly.
(3)

Q. MSW: Make referrals to MSWs for social support and
assessment.
(2)

R. Management Attitude and Support: Management must provide the right goals, support and accountability.
(1)

S. Other: Recommendations that were either environmental or did not fit into another category. (30 – No one theme emerged. Many developed with changing national regulations.)

Sponsor Members:
Bob Fazzi, PhD-Fazzi and Associates
Gina Mazza, RN, BSN-Fazzi and Associates
Mary St. Pierre, BSN, MGA-NAHC
Cyndi Rohret RN, CRNI, CHPN-Briggs Corporation




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