Defragmenting Care
Authors: Stephen F. Jencks
Journal: Annals of Internal Medicine (2010)

Editorials7 December 2010Defragmenting CareStephen F. Jencks, MD, MPHStephen F. Jencks, MD, MPHFrom Baltimore, MD 21210.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-11-201012070-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Rehospitalizations that occur soon after hospital discharge are drawing increasing attention. About 2.5 million Medicare beneficiaries and about 2 million other patients are rehospitalized within 30 days of discharge, with total hospital costs (not including physician services) of about $44 billion (1; Steiner C, Jiang J. Personal communication). From the perspectives of payers, purchasers, and policymakers, avoidable rehospitalizations represent massive and remediable waste. However, most rehospitalization is the result of clinical deterioration, occurs emergently, and is often necessary by the time the patient reaches the emergency department. Some emergency department visits might be prevented from turning into hospitalizations. However, compelling ...References1. Steiner C, Barrett M, Hunter K. Hospital Readmissions and Multiple Emergency Department Visits, in Selected States, 2006–2007. HCUP Statistical Brief #90. Rockville, MD: Agency for Healthcare Research and Quality; 2010. Accessed at www.hcup-us.ahrq.gov/reports/statbriefs/sb90.pdf on 25 October 2010. Google Scholar2. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822-8. [PMID: 17000937] CrossrefMedlineGoogle Scholar3. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52:675-84. [PMID: 15086645] CrossrefMedlineGoogle Scholar4. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150:178-87. [PMID: 19189907] LinkGoogle Scholar5. Society of Hospital Medicine. Project BOOST Mentoring Program. 2008. Accessed at www.hospitalmedicine.org/BOOST on 1 November 2010. Google Scholar6. American College of Cardiology, Institute for Healthcare Improvement. Hospital to Home (H2H) national quality improvement initiative. 2010. Accessed at www.h2hquality.org on 1 November 2010. Google Scholar7. Patient Protection and Affordable Care Act of 2010. Pub. L. No. 111-148, 24 Stat. 119 §3025. Google Scholar8. Weissman JS, Ayanian JZ, Chasan-Taber S, Sherwood MJ, Roth C, Epstein AM. Hospital readmissions and quality of care. Med Care. 1999;37:490-501. [PMID: 10335751] CrossrefMedlineGoogle Scholar9. Kind AJ, Bartels C, Mell MW, Mullahy J, Smith M. For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data. Ann Intern Med. 2010;153:718-27. LinkGoogle Scholar10. Centers for Medicare & Medicaid Services. Home Health Quality Improvement (HHQI) National Campaign. 2010. Accessed at www.homehealthquality.org/hh/default.aspx on 1 November 2010. Google Scholar11. Colorado Foundation for Medical Care. Care Transitions Quality Improvement Organization Support Center. 2010. Accessed at www.cfmc.org/caretransitions on 1 November 2010. Google Scholar12. Institute for Healthcare Improvement. STate Action on Avoidable Rehospitalizations (STAAR) initiative. 2009. Accessed at ihi.org/IHI/Programs/StrategicInitiatives/STateActiononAvoidableRehospitalizationsSTAAR.htm on 1 November 2010. Google Scholar13. Gawande A. The Checklist Manifesto. New York: Metropolitan Books; 2009. Google Scholar14. Epstein AM. Revisiting readmissions—changing the incentives for shared accountability [Editorial]. N Engl J Med. 2009;360:1457-9. [PMID: 19339727] CrossrefMedlineGoogle Scholar15. Patient Protection and Affordable Care Act of 2010. Pub. L. No. 111-148, 24 Stat. 119 §3026. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Baltimore, MD 21210.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2383.Corresponding Author: Stephen F. Jencks, MD, MPH, 8 Midvale Road, Baltimore, MD 21210; e-mail, steve.[email protected]net. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFor-Profit Hospital Status and Rehospitalizations at Different Hospitals: An Analysis of Medicare Data Amy J.H. Kind , Christie Bartels , Matthew W. 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It Is Time to Automate Notification of Hospital Use to Primary Care PracticesInterventions to Reduce 30-Day Rehospitalization: A Systematic ReviewLuke O. Hansen, MD, MHS, Robert S. Young, MD, MS, Keiki Hinami, MD, MS, Alicia Leung, MD, and Mark V. Williams, MDHospital Case Management 7 December 2010Volume 153, Issue 11Page: 757-758KeywordsCaregiversCommunication in health careEmergency departmentHealth careHospitalizationsMedicarePatient Protection and Affordable Care ActPatientsPeer reviewQuality improvement ePublished: 7 December 2010 Issue Published: 7 December 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...