title: Quality collaboratives and campaigns to reduce readmissions: what strategies are hospitals using?
abstract: BACKGROUND
  Reducing hospital readmissions is a national priority, and many hospitals are participating in quality collaboratives or campaigns.
  
  
  OBJECTIVE
  To describe and compare the current use of hospital strategies to reduce readmissions in 2 prominent quality initiatives-STAAR (State Action on Avoidable Rehospitalization) and H2H (Hospital-to-Home Campaign).
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Web-based survey of hospitals that had enrolled in H2H or STAAR from May 2009 through June 2010, conducted from November 1, 2010 through June 30, 2011 (n = 599, response rate of 91%). We used standard frequency analysis and multivariable logistic regression to describe differences between STAAR and H2H hospitals.
  
  
  RESULTS
  Many hospitals were not implementing several of the recommended strategies. Although STAAR hospitals tended to be more likely to implement several strategies, differences were attenuated when we adjusted for region and ownership type. In multivariable models, STAAR hospitals compared with H2H hospitals were more likely to ensure outpatient physicians were alerted within 48 hours of patient discharge (63% vs 38%, P < 0.001), and more likely to provide skilled nursing facilities the direct contact number of the inpatient treating physician for patients transferred (53% vs 34%, P = 0.001). H2H hospitals were more likely to assign responsibility for medication reconciliation to nurses usually or always (80% vs 54%, P = 0.001) and more likely to give most or all discharged patients referrals to cardiac rehabilitation services (59% vs 41%, P = 0.001).
  
  
  CONCLUSIONS
  Substantial opportunity for improvement exists for hospitals engaged in STAAR or H2H quality initiatives.
authors.affiliation: Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.forename: Devi
authors.initials: D
authors.lastname: Mehrotra
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Harlan
authors.initials: H
authors.lastname: Krumholz
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D020407:Internet; D016015:Logistic Models; D059065:Medication Reconciliation / Q000379:methods / Q000458:organization & administration*; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D014481:United States
references.citation: Ann Intern Med. 2009 Feb 3;150(3):178-87
references.pmid: 19189907
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):459-67
references.pmid: 20736442
references.citation: J Rural Health. 2004 Spring;20(2):99-108
references.pmid: 15085622
references.citation: Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):29-37
references.pmid: 20031785
references.citation: J Hosp Med. 2007 Sep;2(5):314-23
references.pmid: 17935242
references.citation: Arch Intern Med. 1997 May 12;157(9):1026-30
references.pmid: 9140275
references.citation: J Gen Intern Med. 2010 May;25(5):441-7
references.pmid: 20180158
references.citation: Crit Care Nurs Q. 2011 Jul-Sep;34(3):235-45
references.pmid: 21670623
references.citation: J Hosp Med. 2013 Aug;8(8):436-43
references.pmid: 23526813
references.citation: JAMA. 2010 May 5;303(17):1716-22
references.pmid: 20442387
references.citation: Ann Intern Med. 2011 Oct 18;155(8):520-8
references.pmid: 22007045
references.citation: Ann Pharmacother. 2010 Oct;44(10):1596-603
references.pmid: 20736427
references.citation: Circ Cardiovasc Qual Outcomes. 2011 Mar;4(2):243-52
references.pmid: 21406673
references.citation: Am J Health Syst Pharm. 2007 Aug 15;64(16):1720-3
references.pmid: 17687061
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):407-13
references.pmid: 20031870
references.citation: J Hosp Med. 2006 Nov;1(6):354-60
references.pmid: 17219528
references.citation: J Am Coll Cardiol. 2002 Jan 2;39(1):83-9
references.pmid: 11755291
references.citation: J Pharm Pract. 2012 Apr;25(2):136-41
references.pmid: 22048929
references.citation: J Hosp Med. 2010 Sep;5 Suppl 4:S1-7
references.pmid: 20842745
references.citation: Arch Intern Med. 2006 Mar 13;166(5):565-71
references.pmid: 16534045
references.citation: J Am Coll Cardiol. 2012 Aug 14;60(7):607-14
references.pmid: 22818070
references.citation: Circ Heart Fail. 2010 Jan;3(1):97-103
references.pmid: 19903931
references.citation: JAMA. 2004 Oct 27;292(16):1961-8
references.pmid: 15507581
references.citation: Ann Pharmacother. 2010 Nov;44(11):1747-54
references.pmid: 20923946
references.citation: JAMA Intern Med. 2013 Oct 14;173(18):1715-22
references.pmid: 23958851
references.citation: Am J Health Syst Pharm. 2009 Dec 1;66(23):2126-31
references.pmid: 19923314
references.citation: J Gen Intern Med. 2012 Sep;27(9):1188-94
references.pmid: 22566172
references.citation: J Gen Intern Med. 2009 Mar;24(3):381-6
references.pmid: 19101774
references.citation: Am Heart J. 2003 Aug;146(2):242-9
references.pmid: 12891191
references.citation: Jt Comm J Qual Patient Saf. 2009 May;35(5):278-82
references.pmid: 19480382
references.citation: Arch Intern Med. 2011 May 9;171(9):860-1
references.pmid: 21555668
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721