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Amarasingham, top left, says the REMPI data helps to determine whether readmissions are actually being reduced. “It's a phenomenal service,” he says.
Amarasingham, top left, says the REMPI data helps to determine whether readmissions are actually being reduced. “It's a phenomenal service,” he says.

Healthcare Market Profile: Dallas-Fort Worth-Arlington

Cutting readmissions: Index allows hospitals to track high-risk patients

By Paul Barr
Posted: July 25, 2011 - 12:01 am ET

While unlikely to overshadow the legend of J.R. Ewing or the dazzle of the Dallas Cowboys cheerleaders, hospitals in the Dallas-Fort Worth region are working to make DFW famous for another reason: reduced hospital readmissions.

Hospitals there are hoping to do that with the assistance of a local master patient index overseen by the Dallas-Fort Worth Hospital Council, Irving, Texas. The council launched the Regional Enterprise Master Patient Index in 2009, and hospitals and researchers are using the information generated by what they call REMPI to track readmissions among all the participating hospitals in the region.

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“We're excited because we're one of the few areas in the country that can track readmissions,” says Steve Love, president and CEO of the hospital council.

The idea is to allow a patient to be tracked no matter which hospital they go to for a given problem, an ability researchers find invaluable. “It's a phenomenal service,” says Dr. Ruben Amarasingham, director of the Center for Clinical Innovation at Parkland Health & Hospital System, Dallas. The REMPI data help answer the question, “Are we truly reducing readmissions?” says Amarasingham, who also is assistant professor of general internal medicine at University of Texas Southwestern Medical Center at Dallas.

Readmissions are becoming more important as the CMS and others look at ways to prevent them, including by changing hospital reimbursement depending on how many patients are being readmitted. Reducing preventable readmissions is one of the two main goals of HHS' recently launched $1 billion patient-safety and cost-control initiative Partnership for Patients (April 18, p. 10). Among the partnership's goals is lowering the rate of hospital readmissions by 20% by the end of 2013, and it has committed $500 million toward the readmissions effort and improving care transitions.

Amarasingham and his colleagues have used the data to create a mathematical model to see who is at high risk for readmission “not only at our hospitals but to other hospitals within 30 days,” he says. Parkland, a public hospital, has been using the data in its readmission prevention effort since December 2009, and in that time has reduced readmissions for Medicare heart failure patients by about 40%, Amarasingham says.

“What they've achieved with this master patient index has directly impacted patient care,” he says.

Similarly, Dr. Amit Khera, director of the preventive cardiology program at UT Southwestern and also an assistant professor of internal medicine and cardiology there, says the REMPI has been “exceedingly valuable.”

Use of the patient data has allowed a large heart disease study the school is working on to more easily track the progress of about 4,000 patients, 2,200 of which have been participating since 2001, Khera says.

“It's extremely efficient to do it this way,” he says. “There are so many researchers across the country that wish they had this resource,” Khera says.

The heart study researchers get an update every quarter on patients in the study, though they confirm information via telephone. He says the telephone follow-up indicates that the REMPI information is very accurate.

REMPI got its start in 2009 and is an overlay of an existing database the council had been running, Love says. REMPI has about 12 years' worth of data and can be used for cross-referencing to certain conditions, such as deep-vein thrombosis, he says.

The index cost about $250,000 and about one year's worth of two full-time equivalents to create. The cost to participating hospitals is determined by a board of member hospitals and community representatives, and hospitals must contribute information to the index to receive information, according to council spokesman Chris Wilson. Fees are annual and correlate to services used and the size of the facilities and systems, he says.

The index includes 8.3 million inpatient visits, 15 million outpatient visits and has been able to identify 6.8 million unique patients.

“We feel good about the investment we made,” Love says.

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