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Bigby_JudyAnn_2Posted by:
JudyAnn Bigby, MD, Secretary of Health and Human Services


One of the top priorities for the Patrick-Murray Administration and the Executive Office of Health and Human Services is to find ways to deliver quality care to individuals and contain the rising costs of health care in the Commonwealth. A key avenue for reducing costs is to lower the rate of hospital readmissions throughout the state by improving the coordination of care people receive across hospital and other settings by multiple providers. Every year (since 2005), the state’s Betsy Lehman Center for Patient Safety and Medical Error Reduction honors a healthcare provider, health organization, or individual for their leadership and innovation in patient safety with the Betsy Lehman Patient Safety Recognition Award. The theme for the 2010 Betsy Lehman Award highlighted the importance of issues related to patient care transitions. A six member Lehman Center Award Review Committee used a set of criteria to evaluate nominees on how well they could demonstrate that their efforts to make improvements had resulted in safer and more effective care transitions for patients across the healthcare continuum.  This year’s award recipient, MetroWest Medical Center/Vanguard Health Systems (MWMC), successfully implemented interventions that resulted in lowering the rate of readmissions for certain patients with congestive heart failure. MWMC has been a participant in the multi-state, multi-stakeholder State Action on Avoidable Re-hospitalizations initiative known as STAAR.

In Massachusetts, more than 10 percent of patients return to the hospital within a month of discharge, and over a two-year period more than a quarter of all patients end up with a repeat visit to the hospital. According to a 2007 Congressional report by the Medicare Payment Advisory Commission, three-quarters of hospital readmissions could be avoided with increased efforts designed to prevent unnecessary rehospitalizations. Massachusetts ranks 37th in the nation on the rate of 30-day readmissions among Medicare beneficiaries, with a rate of 19%. If Massachusetts improved to the same percent of readmissions as the best performing state in the nation, 13%, this would mean $96 million in savings.

As patients travel from one care setting to another, there is always potential for break-downs in communication along the way; poor coordination of care among providers can leave patients, especially those with complex and chronic health care conditions, particularly vulnerable to the occurrence of adverse medical events. Such events can be avoided with more comprehensive discharge practices designed to prevent communication break-down during care transitions.

MWMC introduced multiple strategies for improving communications, including visiting patients more frequently during the initial weeks of their return to homecare and providing standardized teaching materials and discharge materials to patients and their families. These practices, known as 'front loading,' provide more care to patients when they are sickest, allowing clinicians to observe them more closely during this critical time of recuperation.

 MWMC serves as a shining example of the importance of communication between providers and patients and the utility of patient education. In the 11 months following the launch of its participation in the STAAR initiative, MWMC achieved an exceptional level of success: a 50 percent reduction in heart-failure readmissions. MWMC’s coordinated efforts to follow-up with heart-failure patients and ensure direct communication between patients and their doctors is truly exemplary and illustrates how reducing unnecessary hospital readmissions can play a critical role in improving overall care throughout the Commonwealth.

For more information about hospital readmissions:

Written By:

Communications Office

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