Reducing Hospital Readmission Rates -- What Really Works?

Erika Linnander, GHLI Senior Technical Officer

Unplanned hospital readmissions are estimated to cost more than $17 billion each year for Medicare alone. Across the country, hospital executives, clinicians, policymakers, and researchers search for the best ways to reduce unplanned hospital readmissions. Hospitals are intently focused on this issue, and are joining quality improvement networks and programs to guide their efforts. A dizzying array of tools and best practices are available, but which approaches are in fact tied to reduced readmission rates?

Researchers at Yale’s Global Health Leadership Institute continue to study which strategies work best for providing quality patient care and reducing hospital readmissions. Between 2010 and 2012, they found significant increases in the use of nine frequently recommended strategies among hospitals participating in the State Action on Avoidable Rehospitalization initiative or the Hospital-to-Home Campaign.

The latest evidence appearing in the May 2015 issue of the Journal of Internal Medicine shows that hospitals that incorporated any combination of three or more of these strategies which focused on changes to hospital culture and administration, saw significantly larger reductions in risk-standardized readmission than those hospitals that took up fewer strategies. After adjusting for hospital size and location, hospitals that implemented several strategies reduced their readmissions rates by 0.4 percentage points more than hospitals that implemented fewer strategies. Scaled nationally, this improvement could save the Medicare $400 million annually.

The study findings showed rather than a single recipe, many different combinations of strategies led to similar reductions in readmission rates.

What can health care professionals make of these results? First, there is no silver bullet. None of the nine strategies alone accounted for sizable reductions in readmission rates. Second, the successful hospitals were implementing at least three new strategies to reduce readmissions. Because readmissions have multiple root causes, a bundle of strategies is likely needed. Different hospitals used different means for achieving results. Last, change is hard. Despite their enrollment in major quality improvement initiatives, 70% of the hospitals surveyed had taken up fewer than three strategies during the course of the study.