Case Management

Study: Longer stays equal fewer complications and readmissions

Case Management Insider, December 16, 2014

If you want to keep patients from returning to the hospital after discharge, keep them a little longer, says a new study by Columbia Business School in New York, New York.
 
Researchers found that as little as one additional day in the hospital may cut readmissions by 7% for heart failure patients. The Columbia Business School study titled "Should Hospitals Keep Their Patients Longer? The Role of Inpatient and Outpatient Care in Reducing Readmissions," also found that a slightly longer stay can even save
lives, reducing mortality risk for pneumonia patients by 22% and heart attack patients by 7%.
 
“Our findings suggest that for high severity [heart failure] patients, keeping a patient in the hospital one additional day has a similar impact on reducing readmissions as utilizing outpatient programs,” says Carri Chan, a researcher from Columbia Business School, one of the study’s authors. “In so far as managing patient behavior once they are discharged home may be out of the control of a hospital case manager, our study suggests that the inpatient intervention of keeping a patient one more day is just as, if not more, effective. Thus, this may be a more tangible lever for a hospital case manager to rely on for reducing readmissions. For [acute myocardial infarction] and pneumonia patients, it has the effect of reducing mortality rates.”
 
The study also indicated that a longer stay may result in a reduction in certain costs to a hospital.
“Given the stiff penalties imposed under the Affordable Care Act, hospitals are implementing a variety of approaches to aggressively reduce readmission rates, most commonly involving outpatient care,” Ann P. Bartel, professor of finance and economics at Columbia Business School, said in a press release.
 
The study showed that one extra day in the hospital not only prevented readmissions, but also reduced other costs—specifically the associated outpatient care required with early discharge, wrote study authors. “Currently, about one in every five Medicare patients is readmitted to the hospital within 30 days of discharge, costing US taxpayers at least $17 billion annually,” according to the study.
 
Ultimately, the message of the study, says Chan, is that hospitals should err on the side of caution when discharging patients. Hospitals should thoroughly assess patients to ensure that they can maintain their health post-discharge.
 
“We hypothesize that the extra hospital day allows patients to reach a higher level of stability and/or be better educated about their post-discharge behavior, thereby resulting in lower readmission and mortality rates,” says Chan. “As such, it is important for case managers to ensure that discharged patients are truly ready for discharge—medically, cognitively, and socially—before sending them home.”
 

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