Journal article
An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population
Journal of hospital medicine, Vol.16(10), pp.583-588
10/01/2021
DOI: 10.12788/jhm.3659
PMCID: PMC8494282
PMID: 34424188
Abstract
BACKGROUND/OBJECTIVE
Hospital readmissions in the United States, especially in patients at high-risk, cost more than $17 billion annually. Although care transitions is an important area of research, data are limited regarding its efficacy, especially among rural patients. In this study, we describe a novel transitions-of-care clinic (TOCC) to reduce 30-day readmissions in a Veterans Health Administration setting that serves a high proportion of rural veterans.
METHODS
In this quality improvement initiative we conducted a pre-post study evaluating clinical outcomes in adult patients at high risk for 30-day readmission (Care Assessment Needs score > 85) discharged from the Iowa City Veterans Affairs (ICVA) Health Care System from 2017 to 2020. The ICVA serves 184,000 veterans across 50 counties in eastern Iowa, western Illinois, and northern Missouri, with more than 60% of these patients residing in rural areas. We implemented a multidisciplinary TOCC to provide in-person or virtual follow-up to high-risk veterans after hospital discharge. The main purpose of this study was to assess how TOCC follow-up impacted the monthly 30-day patient readmission rate.
RESULTS
The TOCC resulted in a 19.2% relative reduction in 30-day readmission rates in the 12-month postimplementation period compared to the preimplementation period (9.2% vs 11.4%, P = .04). Virtual visits were more popular than in-person visits among both urban and rural veterans. There was no difference in outcomes between these two follow-up options, and both groups had reduced readmission rates compared to non-TOCC follow-up.
CONCLUSIONS
A multidisciplinary TOCC within the ICVA featuring both virtual and in-person visits reduced the 30-day readmission rate. This reduction was particularly notable among patients with congestive heart failure.
Details
- Title: Subtitle
- An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population
- Creators
- Benjamin R Griffin - Iowa City VA Health Care SystemNeeru Agarwal - Iowa City VA Health Care SystemRachana Amberker - Iowa City VA Health Care SystemJeydith A Gutierrez Perez - University of IowaKelsi Eichorst - Iowa City VA Health Care SystemJennifer Chapin - Iowa City VA Health Care SystemAmy C Schweitzer - Iowa City VA Health Care SystemMariko Hagiwara - Iowa City VA Health Care SystemChaorong Wu - University of IowaPatrick Ten Eyck - University of IowaHeather Schacht Reisinger - Iowa City VA Health Care SystemMary Vaughan-Sarrazin - Iowa City VA Health Care SystemEthan F Kuperman - University of IowaKevin Glenn - Iowa City VA Health Care SystemDiana I Jalal - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.16(10), pp.583-588
- DOI
- 10.12788/jhm.3659
- PMID
- 34424188
- PMCID
- PMC8494282
- NLM abbreviation
- J Hosp Med
- ISSN
- 1553-5592
- eISSN
- 1553-5606
- Publisher
- Journal of Hospital Medicine
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health, award: UL1TR002537
- Language
- English
- Date published
- 10/01/2021
- Academic Unit
- Health Management and Policy; Biostatistics; Center for Social Science Innovation; Nephrology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359864802771
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