Healthcare News & Insights

How communities affect readmissions & what hospitals can do

78768320In the quest to reduce readmissions, hospitals are well aware there are many factors outside their control, such as finances and access to follow-up care, causing patients to return to the hospital. A new study supports that belief, but offers help. 

Using available data collected by the Centers for Medicare & Medicaid Services (CMS), researchers looked at the association between the characteristics of hospitals’ surrounding communities and their 30-day readmission rates. Their results were published in the medical journal Health Services Research.

Statistics were reviewed on the county level (or the area’s county equivalent) because there’s a wide variety of data available for analysis in that category.

After comparing characteristics of each county, including socioeconomic factors, population demographics and health-system characteristics, the researchers found that together, these factors accounted for 58% of the variation demonstrated in readmission rates for hospitals.

A hospital’s own performance only accounted for 42%.

Biggest influences

When looking at county statistics, the following specific demographics were associated with higher readmission rates in a hospital:

  • a higher percentage of residents who never got married
  • the number of Medicare beneficiaries per 100,000 residents, and
  • lower rates of employment among residents.

According to researchers, these findings are consistent with other studies showing that single people, the unemployed, and those who don’t have enough money for health care are more likely to be readmitted to the hospital within 30 days.

Other findings

Interestingly, researchers also found a link between lower readmission rates and geographic areas designated as retirement destinations, even though many residents of these areas are eligible for Medicare.

This may be related to economic status more than anything else. Older people living in retirement destinations tend to be better off financially. They may also be living in residences that provide care geared toward their needs as senior citizens (such as independent living facilities).

Another factor that directly affected 30-day readmissions: the number of general practitioners (such as primary care physicians) and specialists in the area, along with the ratio of general practitioners to specialists.

This makes sense. Patients who have difficulty seeing a specialist or doctor immediately after they’re discharged may not get the follow-up care they need, so they’re more likely to fall ill again and end up back in the hospital.

Suggestions for hospitals

Researchers theorized that to improve patient outcomes, government policies should shift away from targeting specific hospitals and toward improving primary care and nursing quality.

Maybe the feds will take that advice in time, but in the meantime, hospitals will bear much of the burden to reduce readmissions. So they’ll have to do what they can to lower their rates.

When it comes to their surrounding communities, hospitals can’t operate in a vacuum. Because community resources have such a big impact on patients’ health, facilities should do what they can to increase people’s access to key healthcare resources.

While hospitals can’t do much to change some of the factors that contribute to readmissions, they can help influence others by forming community partnerships.

The American Hospital Association (AHA) recently released a toolkit hospital execs can follow to guide their facilities toward taking a more active role in their community.

Throughout this process, hospitals should have three key goals, according to the AHA:

  1. Improve the experience of care for patients.
  2. Be proactive about their patients’ health through prevention initiatives.
  3. Promote value-based care by looking for ways to boost efficiency and quality while lowering costs.

Hospitals can achieve these objectives by acknowledging the role they do have in helping their communities boost their health, and making strategic partnerships with other organizations and healthcare providers.

Besides primary care providers and specialists, hospitals can look to form partnerships with organizations that focus on:

  • behavioral health services
  • social services
  • community outreach, and
  • children’s health.

In addition, hospitals can work with entities like nonprofit organizations (e.g., the YMCA, the United Way), universities and food banks. Hospitals may even take a slightly different tactic and partner with other big businesses, like banks and department stores, to create community-focused initiatives to improve people’s general health.

Starting point

When looking at making these alliances, how do you know where to start?

To make this process easier, hospitals should do their homework and speak with community representatives themselves, using what the AHA calls “Community Conversations.”

Here, representatives from key community stakeholder groups are invited to a forum where they can discuss the community’s needs from their perspective. Hospitals can use the information they get from this meeting to shape the decisions about what partnerships they create. Then, they can create a specific blueprint for taking a more active role in improving the communities they serve.

Not only is it beneficial to speak with representatives of these groups with these “Community Conversations,” it could also be helpful to host a public, “town hall” style meeting. Here, both representatives from community organizations and community members themselves could share their thoughts about what kind of services hospitals could provide to be more active participants across the continuum of care.

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