High Rehospitalization Rates: Evaluation and Impact

Transcription

1 High Rehospitalization Rates: Evaluation and Impact May 29, 2009 Denise Remus, PhD, RN Chief Quality Officer, BayCare Health System

2 BayCare Health System BayCare is the largest full-service, community-based health system in the Tampa Bay area. 10 Not-for-Profit Hospitals (9 acute care, 1 LTAC) 2,677 Beds; 119,820 Discharges; 13,554 Births 355,307 Emergency Room Visits 11 Outpatient Centers; 50,904 OP Surgeries 536,642 Home Care Visits; 6.6 million Lab Tests $157 Million Total Community Benefit 17,400 Team Members Around $2 billion in Revenue Data from

3 BayCare s Mission and Values 3

4 What is Quality Healthcare? Quality healthcare means doing the right thing at the right time in the right way for the right person and having the best results possible. Agency for Healthcare Research and Quality, Your Guide to Choosing Quality Healthcare, 4

5 Identify Opportunities Florida Agency for Healthcare Administration (AHCA) Publishing hospital-specific Potentially Preventable Readmission rates (15 days) Include tests of statistical significance, hospital vs expected (Florida) Few areas higher than expected but large numbers of PPR s identified Interested in risk factors across system, opportunities regardless of payer or patient age External data difficult to evaluate Any readmission only have access to details on patients readmitted within our system Reports by Medicare Provider Number or State License multiple hospitals share provider numbers 5

6 Identify Opportunities Continuum of care uncoordinated, lack of information Within system challenge when information systems are different External information not available or incomplete Patients identified as candidates for services but do not meet official criteria, e.g., Medicare s eligibility criteria for home care services 6

7 Potentially Preventable Readmissions (15 days) PPR Analysis of 2008 Inpatient Discharges* Number Percent of Total Total Number of Discharges 148, % Cases excluded / not eligible 52, % Eligible for PPR 89, % Discharges with a PPR or PPR Rate of Total Discharges 5, % Discharges with a PPR from Eligible - PPR Rate 5,582 / 89, % Discharges with > 1 PPR in Chain (range from 3 to 8) - PPR Rate Total 941 / 89, % Discharges with > 1 PPR in Chain (range from 3 to 8) - PPR Rate Eligible 941 / 5, % * PPR analysis of discharges from 12/16/07 to 01/31/2009 7

8 Days from Discharge to First Readmit All cases (all payers, all ages) 8

9 Readmissions by MDC 9

10 Severity of Illness Initial Episode Patients with a higher number of comorbidities (Agency for Healthcare Research and Quality) were significantly more likely to have a PPR (mean 3.0 vs 2.2); all comorbidities were significantly higher except ulcer, lymph and metastasis. Severity of illness and risk of mortality (3M HIS APR-DRG) were also higher 10

11 Readmissions by Payer Significantly Higher: Medicare 11

12 Readmissions by Age and Gender Significantly Higher: * Age 65 to 84 and age 85+ (regardless of gender) * Male gender (compared to female) 12

13 PPR by Discharge Status (Initial Admission Episode) Significantly Higher: Admissions from SNF & ICF Home Health Care 13

14 Charges and Length of Stay for PPR Admissions Charges associated with all readmission episodes (linked PPR chains, all ages) Average = $28,200 Total = $184 million Length of Stay (Days) Average = 6 Total = 39,185 14

15 Additional Work Needed Further exploration of data Physician variables (e.g., primary care, hospitalists) Nursing home variables Other patient risk factors Predictors Data collection, gather evidence Functional status Social network Best practices, evidence-base, spread 15

16 Additional Work Needed Explore and quantify potential benefits of reducing readmissions and impact of lost revenue Room availability (e.g., private) Improve throughput Increased patient satisfaction Model bundled services Expand Information Systems Continue implementation of EMR in hospitals Link key patient data across settings, e.g., acute care to home care Interface to partners Physician office EMR 16

17 Questions? 17