Patient Experience

Improving Patient Experience May Reduce Readmissions

August 6, 2018 3:17 pm

Reducing avoidable readmissions could save $8 billion each year. New research says that how patients feel about their hospital stay care may influence whether they have an avoidable readmission.

In this interview, Jocelyn Carter, an internal medicine hospitalist with the Department of Medicine at Boston’s Massachusetts General Hospital, discusses her research published in BMJ Quality and Safety on the link between patient satisfaction and readmissions.

On her interest in the patient experience.  As an internal medicine hospitalist, Carter became especially curious as to why so many patients returned to the hospital within short periods of time. “Many of these patients had multiple chronic conditions but also had challenges related to their social determinants of health that made it difficult for them to comply with a well-crafted care plan,” says Carter, who is also an instructor of medicine at Harvard Medical School and Mass General. “That made me think that patients were not getting all that they needed, which prompted me to want to ask them more questions while they were admitted to the hospital.”

On the link between high patient satisfaction, good provider communication, and lower readmissions.  Carter and colleagues enrolled 846 patients from two inpatient adult medicine units in their study that spanned from January 2012 through January 2016. Staff interviewed patients just before discharge. Of the enrollees, 23.8 percent were readmitted within 30 days. Patients who reported during the interviews that they were very satisfied with their care were 39 percent less likely to be readmitted within 30 days.

Those who responded that their physicians carefully listened to them were 32 percent less likely to return to the hospital. “I don’t think that’s a coincidence,” she says. “These patients tended to be more satisfied with the care they received and had better outcomes.”

Patient Satisfaction Impacts Readmissions

On avoiding costs by designing a better patient experience.  Being able to reduce readmissions by improving patient satisfaction and provider communication could lead to significant cost savings. Carter points to other research that has found that avoidable readmissions account for 15 to 20 percent of all readmissions and cost between $8 billion and $15 billion each year. “Being able to stop some of these preventable readmissions would be significant on any scale,” she says.

On designing effective care plans.  Designing care plans that take into account both disease-related goals and patients’ own goals are essential.“Being able to understand what matters most to patients when they are getting care—particularly when they are at their most vulnerable during an inpatient stay—is extremely important when we are trying to develop clinical care plans,” Carter says. “I don’t think physicians can really even begin to experience a day in the lives of some of our patients without at least asking some of those questions [about goals] to identify what is on their minds.”

On using the right tools to assess provider communication and patient satisfaction in real time.  “Adding one or two questions on the patient experience as part of the outtake process at the end of a hospitalization could be highly effective at identifying patients at high risk for readmission,” Carter says. “It also might reveal the reasons why patients feel they are at high risk for readmission, which could then be mapped to potential solutions.”

Even though predictive risk-scoring tools are pervasive throughout the industry, she does not believe an algorithm has been developed that effectively incorporates patient experience factors.

One of the reasons is that the current crop of tools are focused mostly on objective data, such as disease comorbidities, demographics, and other factors that can be extracted easily from the electronic health record (EHR). However, Carter is hopeful that future tools will include a few patient experience factors to help providers gauge the risk of readmission.

In practice, this might be as simple as asking patients a question such as “Do you feel like you are being listened to carefully by your doctor?” during their hospitalization.

On targeting the right patients.  Carter believes organizations can start by targeting patients with a high risk of readmission, particularly high utilizers with chronic diseases. “We know that 80 percent of healthcare costs are generated by approximately 20 to 25 percent of our U.S. population,” she says. “It is important to focus on patients who have a certain number of readmissions per quarter or per year and have certain comorbidities, such as congestive heart failure, serious infections like sepsis, or myocardial infarctions.”

Advice for finance leaders.  When trying to assess the patient experience in their organization, leaders should be mindful of the time constraints physicians and other care providers face, Carter says. Rather than putting additional tasks and pressures on clinicians, leaders should arm them with analytics to help them identify and monitor patients at high risk for readmission.

“If we could leverage these tools to include some patient experience standards, it would cut an extraordinary amount of time and effort that might go into getting this data otherwise,” she says.

Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.

Interviewed for this article:

Jocelyn Carter, MD, MPH, is an internal medicine hospitalist with the Department of Medicine at Massachusetts General Hospital, Boston.


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