Complex Case Conferences Associated with Reduced Hospital Admissions for High-Risk Patients with Multiple Comorbidities
| Autor: | Sandra Y Koyama, Philip Tuso, Lynn Garofalo-Wright, Ana H Jackson, Heather L Watson, Gail Lindsay, Michael H. Kanter, Maria Taitano |
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| Rok vydání: | 2014 |
| Předmět: |
Heart Failure
medicine.medical_specialty High risk patients business.industry Psychological intervention Aftercare Comorbidity General Medicine Physician Office medicine.disease Social issues Home Care Services Patient Readmission Patient-Centered Care Intervention (counseling) Health care Emergency medicine Humans Medicine Medical emergency business Case Management Health care quality |
| Zdroj: | The Permanente Journal. 18:38-42 |
| ISSN: | 1552-5775 1552-5767 |
| DOI: | 10.7812/tpp/13-062 |
| Popis: | OBJECTIVES Reducing avoidable hospital readmissions presents an opportunity to improve health care quality and reduce avoidable costs. We studied the effect person-focused care may have on reducing avoidable admissions to the hospital. METHODS Among patients with heart failure discharged from the hospital, we evaluated the effect on 30-day readmissions of transitions-in-care interventions: home health visits, follow-up phone calls, and physician office visits. We also used a standardized diagnostic tool to interview readmitted patients to identify social reasons that may have contributed to the readmission. Finally, we used the learnings from both interventions to develop a new intervention: a single complex disease case conference that included the entire health care team. We measured hospital admissions for 21 patients during the 6 months before and after their complex case conferences. RESULTS Observed-over-expected hospital readmission rates were lowest for patients receiving a postdischarge visit with a home health nurse and a follow-up visit with their physician (0.54), compared with solely a physician visit (0.81), home health visit (1.2), or phone call (1.55). Various social issues may contribute to hospital readmissions, including caregiver knowledge, ability to care for oneself at home, and issues related to medications (adherence, ability to pay, and knowledge about potential side effects). Substantially fewer hospital admissions occurred after complex case conferences. CONCLUSIONS Complex case conferences with disease-focused and person-focused interventions may be associated with reduced hospital admissions for patients with heart failure and multiple comorbidities. |
| Databáze: | OpenAIRE |
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