title: Interventions for Reducing Hospital Readmission Rates: The Role of Hospice and Palliative Care.
abstract: BACKGROUND
  Despite evidence that enrollment with hospice services has the potential to reduce hospital readmission rates, previous research has not examined exactly how hospitals may promote the appropriate use of hospice and palliative care for their discharged patients. Therefore, we sought to explore the strategies used by hospitals to increase the use of hospice and palliative care for patients at risk of readmission.
  
  
  METHODS
  We conducted a secondary analysis of qualitative data from a study of hospitals that were participating in the State Action on Avoidable Readmissions (STAAR) initiative, a quality improvement collaborative. We used data attained from 46 in-depth interviews conducted during 10 hospital site visits using a standard discussion guide and protocol. We used a grounded theory approach using the constant comparative method to generate recurrent and unifying themes.
  
  
  RESULTS
  We found that a positive effect for hospitals participating in the STAAR initiative was enhanced engagement in efforts to promote greater use of hospice and palliative care as a possible method of reducing unplanned readmissions, the central goal of the STAAR initiative. Hospital staff described strategies to increase the use of hospice and palliative care that included (1) designing and implementing tracking systems to identify patients most at risk of being readmitted, (2) providing education about hospice and palliative care to family, internal and external clinical groups, and (3) establishing closer links to posthospital settings.
  
  
  CONCLUSIONS
  National efforts to reduce rehospitalizations may result in improved integration of hospice and palliative care for patients who are at risk of readmission.
authors.affiliation: 1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.|2 Yale Global Health Leadership Institute, New Haven, CT, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.affiliation: 1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.|2 Yale Global Health Leadership Institute, New Haven, CT, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Brewster
authors.affiliation: 1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.|2 Yale Global Health Leadership Institute, New Haven, CT, USA.|3 Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.affiliation: 1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.|2 Yale Global Health Leadership Institute, New Haven, CT, USA.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.affiliation: 4 The Connecticut Hospital-Hospice, Branford, CT, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Hurzeler
authors.affiliation: 1 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.|2 Yale Global Health Leadership Institute, New Haven, CT, USA.|3 Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D066296:Grounded Theory; D017051:Hospice Care / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D010166:Palliative Care / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement
keywords: hospice; hospital readmission; hospital-based palliative care; palliative care; qualitative analyses; reducing hospital readmissions