State quality projects curbed readmissions: study

A Medicare initiative aimed at smoothing transitions of care through community-based interventions successfully lowered 30-day readmission rates and all-cause hospitalization rates among beneficiaries, according to a study.

Led by Medicare quality improvement organizations (QIOs), which contract with the CMS to lead statewide quality-related efforts, the 14-community project relied on patient coaches, medication-management strategies, home health tool kits, enhanced discharge planning and other interventions to keep patients out of the hospital.

Communities that had multistakeholder care-transition programs in place had lower rates of 30-day all-cause readmissions and all-cause hospitalizations than did comparison communities with no such interventions, according to the study, which appeared in the Journal of the American Medical Association.

Mean 30-day readmission rates per 1,000 beneficiaries in communities with QIO-led projects fell from 15.21 in 2006 through 2008 to 14.43 in 2009 and 2010, when the interventions were implemented. That's a larger drop than was seen in 50 comparison communities, where 30-day all-cause readmission rates fell from 15.03 to 14.72 during the same periods, the authors found.

Additionally, all-cause hospitalization rates per 1,000 beneficiaries fell an average of 5.74% in the communities with care-transition programs, compared with a 3.17% average decrease among the 50 comparison communities.

Despite those differences, there was no change in the rate of 30-day readmissions as a percentage of hospital discharges, an often used metric, between the intervention and comparison groups. “In this project, the reductions coincident with the (quality improvement) work were equal for rehospitalizations and hospitalizations, thus reducing the numerator and denominator equally and leaving the rate unchanged,” the authors explained in the study.

The federal government has paved the way for many similar initiatives, they added, citing the healthcare reform law's Community-Based Care Transitions Program and HHS Partnership for Patients, a federal initiative whose goals include a 20% drop in readmissions by the end of 2013.