US: Quality improvement measures cut hospital readmissions but do not always produce savings

Efforts to reduce hospital readmissions are working, but they are not always saving money, according to a new study by healthcare provider Cedars-Sinai, which systematically evaluated the effectiveness and financial benefit of quality improvement programmes at medical centres in the US and elsewhere.

The team conducted a systematic review of data from 50 quality improvement studies involving more than 16,700 patients. Among other findings, the researchers report that quality improvement interventions reduced readmissions by an average of 12.1 per cent for heart failure patients and 6.3 per cent for older adults with diverse health issues.

But the savings to health systems varied. The investigators gauged how much money these interventions saved or cost health systems by measuring expenses for hospitals, physicians, other providers and payers. They found average net savings for health systems of $972 per person among heart failure patients and average net losses of $169 per person among other patients.

However, costs varied so widely across studies that the researchers could not conclude definitively whether these interventions saved or lost money.

Among older adults, interventions that engaged patients and caregivers yielded the most net savings per patient. For example, several interventions involved nurses or pharmacists training patients and family members about how to manage medications after discharge, which types of activities are appropriate and which symptoms might represent something serious.

Lead author Teryl Nuckols, director of the Division of General Internal Medicine in the Cedars-Sinai Department of Medicine, is surprised that the interventions did not save more money across the board, countering a widely held belief that reducing readmissions should save money. Adding urgency to the study, the Centers for Medicare & Medicaid Services now penalise institutions for excessive readmissions. As a result, almost 2,600 hospitals are expected to lose a total of more than $500 million in payments this year, according to analysis of government data by Advisory Board, a healthcare consulting and research firm.

“Hospitalisation is very expensive, so avoiding even a few readmissions should have saved a lot of money. Our findings suggest that there is no guarantee of net cost savings once the implementation costs associated with efforts to prevent readmissions are considered,” Nuckols said.

The study is published in the Journal of the American Medical Association Internal Medicine: doi:10.1001/jamainternmed.2017.1136

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