In early 2010, New York Methodist Hospital was, like most U.S. hospitals, searching for effective ways to curb its stubbornly high rates of preventable hospital readmissions.
Less than a year earlier, the New England Journal of Medicine published a landmark study reporting that one-fifth of Medicare beneficiaries ended up back in the hospital within 30 days of discharge, at an annual cost of $17.4 billion. That study and others like it led to a growing awareness of the problem and a call for changes that would eventually include financial penalties for excess Medicare readmissions.
At that time, New York Methodist's 30-day readmission rate among congestive heart-failure patients was above 25%, compared with the national rate of 24%. The hospital's troubling performance was the result of a number of factors, including a high percentage of patients from nursing homes, said Dr. John Heitner, director of noninvasive imaging and the cardiology fellowship program at the 591-bed Brooklyn hospital. “We knew we needed to do something,” he said.
The hospital had a successful program in place that used specially trained volunteers to improve patients' health literacy. Heitner and Mimi Makovitzky, the hospital's director of educational and volunteer resources, decided to test whether volunteers also could be used to improve the discharge process and reduce the number of patients unnecessarily returning to the hospital.
Heitner decided to conduct the project as a research study to determine what worked and what didn't. From June through December of 2010, he and his colleagues enrolled 137 patients with congestive heart failure. Half received standard care, and half received specialized dietary and medication instructions from student volunteers, along with a follow-up telephone call and weekly check-in calls for one month following discharge.
The results were striking, Heitner said. Only 7% of patients in the group who received volunteer help were readmitted within 30 days, compared with 19% in the control group. “It was a remarkable drop and we were just thrilled,” he said.