title: Reducing Unplanned Medical Oncology Readmissions by Improving Outpatient Care Transitions: A Process Improvement Project at the Cleveland Clinic.
abstract: Reducing 30-day unplanned hospital readmissions is a national policy priority. We examined the impact of a quality improvement project focused on reducing oncology readmissions among patients with cancer who were admitted to palliative and general medical oncology services at the Cleveland Clinic.
  
  
  
  Baseline rates of readmissions were gathered during the period from January 2013 to April 2014. A quality improvement project designed to improve outpatient care transitions was initiated during the period leading to April 1, 2014, including: (1) provider education, (2) postdischarge nursing phone calls within 48 hours, and (3) postdischarge provider follow-up appointments within 5 business days. Nursing callback components included symptom management, education, medication review/compliance, and follow-up appointment reminder.
  
  
  
  During the baseline period, there were 2,638 admissions and 722 unplanned 30-day readmissions for an overall readmission rate of 27.4%. Callbacks and 5-day follow-up appointment monitoring revealed a mean monthly compliance of 72% and 78%, respectively, improving over time during the study period. Readmission rates declined by 4.5% to 22.9% (P < .01; relative risk reduction, 18%) during the study period. The mean direct cost of one readmission was $10,884, suggesting an annualized cost savings of $1.04 million with the observed reduction in unplanned readmissions.
  
  
  
  Modest readmission reductions can be achieved through better systematic transitions to outpatient care (including follow-up calls and early provider visits), thereby leading to a reduction in use of inpatient resources. These data suggest that efforts focused on improving outpatient care transition were effective in reducing unplanned oncology readmissions.
authors.affiliation: Cleveland Clinic, Cleveland, OH montero2@ccf.org.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Montero
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: James
authors.initials: J
authors.lastname: Stevenson
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Guthrie
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Best
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Lindsey Martin
authors.initials: LM
authors.lastname: Goodman
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Shiva
authors.initials: S
authors.lastname: Shrotriya
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Abdel-Ghani
authors.initials: AG
authors.lastname: Azzouqa
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Armida
authors.initials: A
authors.lastname: Parala
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lagman
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Matt E
authors.initials: ME
authors.lastname: Kalaycio
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Alok A
authors.initials: AA
authors.lastname: Khorana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002173:Cancer Care Facilities; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D010359:Patient Readmission; D017064:Process Assessment, Health Care; D055815:Young Adult