News Feature | April 30, 2014

UNC Clinic Cuts Re-Admissions 65%

Christine Kern

By Christine Kerncontributing writer

UNC Clinic Cuts Re-Admissions

Standardizing post-discharge reduces readmissions dramatically.

Standardizing post-discharge care at one of the University of North Carolina Hospitals clinics reduced readmissions by 65 percent, according to a study published in the Journal of General Internal Medicine. The study also found that one 30-day readmission is avoided for every seven patients cared for under the new program.

Approximately 20 percent of Medicare beneficiaries discharged from the hospital are readmitted within 30 days, costing approximately $17.4 billion annually, thus creating incentive to reduce re-admissions.

According to a UNC press release, “Patients don’t want to come back to the hospital, and we don’t want them to if we can prevent it,” said Jamie Cavanaugh, PharmD, lead author of the study and assistant professor in the UNC Eshelman School of Pharmacy and the UNC School of Medicine. “At UNC we’ve shown that pharmacists, physicians, and social workers working together can cut readmissions by almost two-thirds. That saves time, saves money, and saves the patient and their family from another hospital stay," Cavanaugh said.

The focus of the study was an evaluation of a new post-discharge care program created by the Internal Medicine Clinic at UNC Hospitals that includes identification of patients who have been discharged, a process for contacting patients after hospital discharge via a dedicated care manager, and standardization of the hospital follow-up appointment content. The hospital follow-up appointments are conducted by clinical pharmacist practitioner and a physician.

The program evaluation compared readmission rates of UNC Internal Medicine Clinic patients seen in the hospital follow-up clinic with those who did not receive the enhanced services. Patients in both groups were discharged from the hospital in the same month and were selected at random. The study evaluated hospital readmission at 30 and 90 days as well as emergency department utilization, and found striking reductions: twenty-four patients in the control group were either readmitted or visited the ED within 30 days, compared to 10 patients in the program.

According to the study report, based on these preliminary data, key components of success include real-time care management, improved access to care, and content standardization in a multidisciplinary visit. It concluded that rate of re-admission can be reduced through attention to primary care practice structure in the transition from inpatient to outpatient settings. This approach takes advantage of the relationship between the patient and the primary care home and may facilitate a more efficient and effective model of care.