PICOT correction in evidence based revised; CORRECTIONS to paper; revision; use analytical data

Running Head: HOSPITAL READMISSIONS 1

HOSPITAL READMISSIONS 6

Hospital Readmissions

Hospital readmission is usually an avoidable occurrence through quality care, bearing in mind that it is expensive. Health care providers need to identify patient needs and work to reduce the probability of readmission. Provision of the Hospital Readmissions Reduction Program (HRRP), following the Affordable Care Act, aims at reducing excessive and unnecessary readmissions, taking steps against hospitals that do so. The Act provides that if a hospital is found to have readmissions that are determined to be excessive, the United States Centers for Medicare and Medicaid Services (CMS) reduces the payment to the hospital (Gai & Pachamanova, 2019). The HRRP was keen on pneumonia, congestive heart failure, and acute myocardial infarction and has since added more conditions to the target list.

Clinical Question

In Medicare beneficiary's population, does bed-side teaching from nurses reduce hospital readmission compared to the implementation of the Hospital Readmissions Reduction Program (HRRP) within thirty days after discharge? The research aims to describe the evidence-based interventions applied in hospitals and by the CMS that could help prevent hospital readmission.

Level of Evidence

There have been studies that have shown that HRRP has reduced readmissions on Medicare patients with pneumonia, acute myocardial infection, and heart failure. According to Medicare data, hospitals that had the most improvement were those with a previous low performance before HRRP was introduced. Since the implementation of the HRRP, the CMS reported patient outcomes for the targeted diseases and announced them publicly to improve transparency and foster accountability in hospitals (CMS, 2020). The CMS calculated the data between July 2008 and June 2011, and the rates were adjusted concerning pre-existing medical conditions, gender, age, and other underlying conditions. They were compared to a control method formulated by the National Quality Forum (NQF). It was found that about 80% of hospitals had excess readmissions and were therefore penalized. Reports showed that four out of five hospitals were punished during the three years. The CMS issued financial penalties capped at 3%.

Moreover, the penalties and mandates were made public. The CMS gives reports that are specific to hospitals in which readmission rates, risk factor data, and discharge data. Available data shows that large and referral hospitals were more likely to have readmissions that small and non-teaching hospitals, and would, therefore, be penalized more by the HRRP (CMS, 2020). The evidence shown above shows the substantial impact HRRP has on reducing unnecessary patient readmissions.

Search Strategy

The search for peer-reviewed articles written between 2015 and 2020 was done through databases such as JSTOR, Sage Journals, PubMed, Springer, PMC, NCBI, and Med Scape. Google Scholar was also used to locate articles (Houser, 2018). The following terms were used during the search; hospital readmission, reduction in hospital stay, Medicare, hospital, discharge, HRRP reductions, acute myocardial infarction, heart failure, and pneumonia. Variations of these words were used to get different results. One of the studies (Chen & Grabowski, 2017) was done to investigate whether or not the HRRP's penalty actions have reduced unnecessary readmissions in hospitals. It was done in hospitals within Florida, and results showed that implementation of the program resulted in a 1- 2% reduction in the likelihood of readmission for patients with the targeted diseases (Chen & Grabowski, 2017). The method used was collecting patient data from hospital admissions and readmissions departments. The information was used to determine patient readmission rates. In another study to find the association between HRRP and change in patient mortality, a retrospective design was used on patients hospitalized for the target diseases. The study span for four periods over ten years. Results showed a decline in patient mortality after discharge in acute myocardial infarction (AMI). In patients with pneumonia, death rates were stable before HRRP implementation but were significantly improved after implementation (Wadhera et al., 2018). Results showed that the mortality that resulted from pneumonia and heart failure was mainly to patients that were not readmitted. For all conditions, HRRP implementation was found to reduce mortality in all targeted diseases. Albeit these results, further studies need to be done since the association with HRRP was not clear (Wadhera et al., 2018). The author of the study did not think that the retrospective study was reliable to give results for the association. Moreover, the study results showed concern that efforts to reduce the financial burden of readmissions could have had adverse effects on patients with the target disease (Chen & Grabowski (2017) approved the validity of hospital data use to show the impact of HRRP implementation.

Conclusion

The articles that were reviewed showed an improvement in patient outcomes after the implementation of HRRP. In all the studies, the researchers used hospital data to compare patient admission and readmission rates before and after. Apart from the targeted diseases, the CMS plans to include more conditions into the program, such as chronic obstructive pulmonary disease (COPD), among others, to increase patient outcomes. The CMS has taken practical steps to improve the health care system and reduce unnecessary readmissions, saving taxpayer money, and patient finances (Gai & Pachamanova, 2019). Hospitals are becoming cautious as penalties have been put in place for hospitals that do not comply with guidelines set in place to determine the validity of readmissions. This step helps to improve health care in all sectors as overall patient care is improved, reducing post-discharge mortality.

References

Chen, M., & Grabowski, D. C. (2019, October). Hospital Readmissions Reduction Program: Intended and Unintended Effects. PubMed.

CMS. (2020, February 11). Hospital Readmissions Reduction Program (HRRP). CMS Homepage | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

Gai, Y., & Pachamanova, D. (2019, November 14). Impact of the Medicare Hospital Readmissions Reduction Program on vulnerable populations. BMC Health Services Research. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4645-5

Houser, J. (2018). Nursing research: Reading, using and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning

Wadhera, R. K., Maddox, K. E. J., Wasfy, J. H., Haneuse, S., Shen, C., & Yeh, R. W. (2018). Association of the Hospital Readmissions Reduction Program with mortality among Medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, and pneumonia. Jama, 320(24), 2542-2552.