Hospital Readmission Reduction
Scenario
You are the senior clinical analyst for the Oakridge Health System. Oakridge Health System is comprised of Medicare-certified hospitals, home health, hospice, inpatient rehabilitation and long-term care facilities. The Chief Medical Officer (CMO) needs to identify a quality improvement initiative for the next fiscal year. You are tasked to write a white paper outlining the quality of care for Medicare-certified hospitals across the country.
Instructions
Your white paper should include:
Analyze your state (ANY STATE) and national health care quality based on the most recent year (2024) of data reported by Centers for Medicare & Medicaid Services.
- Identify one quality measure from your analysis to recommend for an initiative.
- Provide an evaluation of the quality measure outcomes using quality improvement principles that will support your initiative recommendation.
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Hospital Readmission Reduction
National and State Overview
In 2024, data from the Centers for Medicare & Medicaid Services (CMS) revealed national strides in improving hospital quality. However, hospital readmission rates remained a concern. Nationally, the average 30-day readmission rate hovered around 15.3%. In Texas, the rate stood at 16.2%, slightly above the national average. This suggests a need for targeted strategies in transitional care, especially for chronic conditions like heart failure and COPD. Addressing readmissions could significantly improve care outcomes and reduce Medicare costs.
Recommended Quality Measure
The 30-day hospital readmission rate is the most actionable and impactful quality measure. Readmissions not only indicate potential lapses in discharge planning but also reflect post-discharge care deficiencies. This measure affects both patient outcomes and hospital reimbursement rates under CMS. Focusing on this metric aligns with Oakridge Health System’s mission of delivering cost-effective, high-quality care across its Medicare-certified facilities. It can also improve patient satisfaction and trust.
Evaluation Using Improvement Principles
Using the Plan-Do-Study-Act (PDSA) cycle, Oakridge can design and implement interventions such as enhanced discharge planning, post-discharge follow-up calls, and home health services. These steps can ensure continuity of care. Data tracking will be essential to monitor trends. Root cause analyses should also be used to investigate specific readmission causes. Quality improvement tools like fishbone diagrams can identify system-level weaknesses that contribute to readmissions.
Initiative Recommendation
Based on national and state data, reducing 30-day hospital readmissions should be prioritized. This initiative is measurable, evidence-based, and aligns with CMS quality goals. With proper implementation and ongoing evaluation, Oakridge can not only reduce readmissions but also improve patient safety and operational efficiency. A targeted, system-wide approach will help ensure long-term success.
