title: Description and Impact Evaluation of a Statewide Collaboration to Reduce Preventable Hospital Readmissions.
abstract: This article describes how a Medicare-funded Quality Improvement Organization collaborated with a hospital association and multiple cross-continuum partners on a statewide effort to reduce hospital readmissions. Interventions included statewide education on quality improvement strategies and community-specific technical assistance on collaboration approaches, data collection and analysis, and selection and implementation of interventions. Fifteen communities, comprising 16 acute care hospitals, 119 nursing homes, 70 home health agencies, and 32 other health care or social service providers, actively participated over a 4.5-year period. Challenges included problems with end-of-life discussions (80.0%), physician engagement (70.0%), staffing (70.0%), and communication between settings (60.0%). Thirty-day all-cause readmission rates in fee-for-service Medicare patients decreased in most hospital service areas across the state (22/24), and the aggregate statewide readmission rate dropped from 15.2/1000 to 12.1/1000, a relative decrease of 20.3% ( P < .001). Despite these positive findings, the specific impact of this collaboration could not be determined because of multiple confounding interventions.
authors.affiliation: 1 Qualidigm, Wethersfield, CT.|2 Quinnipiac University, North Haven, CT.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Meehan
authors.affiliation: 1 Qualidigm, Wethersfield, CT.
authors.forename: Anne
authors.initials: A
authors.lastname: Elwell
authors.affiliation: 1 Qualidigm, Wethersfield, CT.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Meehan
authors.affiliation: 1 Qualidigm, Wethersfield, CT.
authors.forename: Shih-Yieh
authors.initials: SY
authors.lastname: Ho
authors.affiliation: 1 Qualidigm, Wethersfield, CT.|3 University of Connecticut School of Nursing, Storrs, CT.|4 University of Connecticut School of Medicine, Farmington, CT.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Van Hoof
authors.affiliation: 1 Qualidigm, Wethersfield, CT.
authors.forename: Dan
authors.initials: D
authors.lastname: Ray
authors.affiliation: 1 Qualidigm, Wethersfield, CT.
authors.forename: Casey
authors.initials: C
authors.lastname: Thomas
authors.affiliation: 5 Connecticut Hospital Association, Wallingford, CT.
authors.forename: Alison
authors.initials: A
authors.lastname: Hong
authors.affiliation: 6 University of Connecticut Health Center, Farmington, CT.
authors.forename: Wendy
authors.initials: W
authors.lastname: Martinson
authors.affiliation: 7 Middlesex Hospital, Middletown, CT.
authors.forename: Terri
authors.initials: T
authors.lastname: Savino
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003256:Community Participation / Q000379:methods; D018588:Fee-for-Service Plans; D006801:Humans; D007318:Inservice Training; D007373:Interinstitutional Relations; D006278:Medicare / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000458:organization & administration; D015279:Organizational Culture; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration*; D018570:Risk Assessment; D013727:Terminal Care; D014481:United States
keywords: care transitions; hospital readmissions; quality improvement