AUSTIN, TX--(Marketwire - Jan 23, 2013) - Hospitalizations and rehospitalizations among Medicare patients declined nearly twice as much in communities where Quality Improvement Organizations (QIOs) coordinated interventions that engaged whole communities to improve care than in comparison communities, according to a study in the January 23rd issue of the Journal of the American Medical Association (JAMA).
The results show that interventions aimed at improving care transitions -- when patients move from one care setting to another, such as from a hospital to their home -- reduced rehospitalizations for Medicare patients by almost 6 percent in 14 select communities nationwide, including in Texas' Rio Grande Valley. TMF Health Quality Institute is one of the 14 state-based QIOs that received funding from the Centers for Medicare & Medicaid Services (CMS) to participate in the project.
Building on the project's initial success, TMF has expanded projects to improve care transitions to communities across Texas, including: Beaumont, Brownsville, Denton, El Paso, Harlingen, Katy, Laredo, Lubbock, Lufkin, McAllen, Nacogdoches, Sherman, Temple and Waco.
Readmitting Medicare patients to the hospital within a month of discharge is a frequent -- and costly -- occurrence. Almost 25 percent of heart failure patients on Medicare, for example, are readmitted to the hospital within 30 days of discharge. The federal government says avoidable hospital readmissions cost the Medicare program billions of dollars a year.
The study appearing in JAMA shows how state-based QIOs, funded by the Medicare program, systematically coordinated community-based efforts with hospitals to improve the quality of care transitions and avoid costly readmissions. The 14 communities in the study averaged a 5.7 percent reduction in rehospitalizations. A less expected result was that Medicare beneficiaries in the communities also experienced a 5.74 percent reduction in hospitalizations over the two-year period.
In the Rio Grande Valley, there was an 11.6 percent reduction in rehospitalizations of Medicare patients and an 8.6 percent reduction in hospitalizations.
"To successfully reduce readmissions, health care providers throughout the community worked together to improve communication and coordination as patients transitioned between care settings," said Tom Manley, President and CEO of TMF. "Today, TMF is proud to be working with more than a dozen communities in Texas to support local collaborations that are helping to keep our seniors from going back to the hospital for something that could have been avoided."
Hospitals throughout the nation are doubling down on efforts to improve care transitions and avoid readmissions, due to both the growing awareness of the burdens placed on patients and families through poor transitional care, and the new penalties assessed by the federal government on hospitals with high rates of readmission for Medicare patients.
The community-based approach coordinated by TMF and other QIOs in the study was markedly different from commonly used hospital-based approaches to improve care transitions, which have often focused on interventions among patients with a specific disease or in a specific hospital unit.
"The QIOs' work in this project shows a reduction in hospitalization and rehospitalization rates, which are vitally important for keeping Medicare beneficiaries as healthy as possible for as long as possible," said Patrick Conway, MD, MSc, CMS Chief Medical Officer and Director of the Agency's Center for Clinical Standards & Quality.
"This project demonstrates that QIOs can build social capital in communities towards a noble goal -- taking care of their own," said Conway. "Thanks to QIOs, these communities created networks of clinicians, facilities, families, social service agencies and others that share a common language in coordinating care for patients -- the community's sickest and most vulnerable people. These communities effectively prevented hospitalizations, resulting in people being more likely to stay home and healthy."
TMF quality improvement consultants worked with health care providers in the Rio Grande Valley to implement interventions to improve medication management, post-discharge follow-up, communication and coordination of care. In addition, TMF promoted increased self-management of chronic disease for patients and caregivers through education and support, including training on how to use a personal health record.
Within the 14 communities, researchers found that quality improvement interventions prevented about 6,800 hospitalizations and 1,800 rehospitalizations per year. In an average community of 50,000 fee-for-service Medicare beneficiaries, the project would have saved Medicare more than $4 million per year in hospitalization costs, while costing less than $1 million per community per year to implement.
The U.S. Department of Health & Human Services has also established a goal of 20 percent reduction in avoidable readmissions, and CMS is now funding all QIOs nationally to continue community-based readmissions reduction initiatives through July 2014.
For more information about TMF's efforts to improve quality of care for patients, visit www.tmf.org.
About TMF Health Quality Institute
TMF Health Quality Institute focuses on improving lives by improving the quality of health care through contracts with federal, state and local governments, as well as private organizations. For more than 40 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients.