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Drilling Down on Readmissions

May 13, 2011
by Mark Hagland
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Following an eye-opening study, one hospitalist leader sees much room for process improvement

Earlier this spring, the Waltham, Mass.-based QuantiaMD, an online physician-to-physician learning collaborative, released the results of a study that focused on the need for the training, education, and resources needed in order to help physicians participate in initiatives to reduce hospital readmissions. Over 1,000 physicians nationwide participated in the study.

Significantly, while more than 9 out of 10 physicians working in hospitals believe that reducing readmissions is an important area of endeavor, 71 percent of those surveyed by QuantiaMD told researchers that their organizations’ systems and procedures for averting readmissions among high-risk patients were not very effective. Most also said that their organizations don’t currently provide adequate training and education in that area, with 54 percent saying the current training and educational opportunities at their organizations did not adequately focus on reducing readmissions.

Respondents most frequently reported that they treated patients presenting with the following conditions most commonly associated with hospital readmissions: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pneumonia, coronary artery disease (CAD), and psychiatric illness.

One physician leader working intensively in the area of readmissions work, and who cooperated with QuantiaMD researchers in their study, is Mark V. Williams, M.D., professor and chief of the Division of Hospital medicine at the Northwestern University Feinberg School of Medicine, and principal investigator, Project BOOST, all in Chicago. Project BOOST is a leading-edge program, sponsored by the Society of Hospital Medicine (SHM; the national professional association of hospitalists) that incorporates mentorship and a resource kit developed by Williams and other physicians expert in the field, and which is being implemented in hospitals across the country in order to address readmissions issues.

Williams, who works as a hospitalist at Northwestern Memorial Hospital in Chicago, and who is a past president of SHM, spoke recently with HCI Editor-in-Chief Mark Hagland regarding the implications of the QuantiaMD study for readmissions work in the hospital setting. Below are excerpts from that interview.

What are your reactions to the results of this study?
I think hospitalists are paying attention to this. I think that A) they recognize this as an important issue; and B) I think they don’t feel adequately prepared.

Mark V. Williams, M.D.

You’re in charge of the hospitalists at Northwestern Memorial, correct?
Yes, that’s right. And the study’s respondents represent a sample of hospitalists nationwide who log into the Quantia website. What’s striking is the percentage of physicians who feel they need additional training, combined with the high proportion who feel this is very important. So this provides a sort of unexpected needs assessment that provides insight into this area.

What kinds of areas do you see as ripe for training and education?
Well, I would recommend that this be undertaken in a somewhat different way from the standard conference course or didactic teaching or online work; instead, it demands involvement in quality improvement initiatives. Interestingly, the American Medical Association is now providing CME that can be obtained through participation in a quality improvement project; and the American Board of Internal Medicine provides maintenance of certification credits for when physicians re-certify in their area of specialty; and now you can get those credits for participating in Project BOOST, for example. Go to our website: www.hospitalmedicine.org/boost. That’s the website for the Society of Hospital Medicine. I’m currently editor in chief of our peer-reviewed journal, the Journal of Hospital Medicine.

Within the context of readmissions work, what aspects would be most interesting?


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When you state "Making sure that the discharge summary is included immediately in the electronic medical record, for appropriate reference by clinicians." This is a good argument for the widespread adoption of voice recognition software in the healthcare setting. When one uses voice recognition software to dictate a critical note, such as an admission note, consultation note, procedure note, or discharge summary, it is immediately available in the medical record without the delays required by conventional transcription.

thank you for the article,Mark!
i agree with you on reducing readmissions
bookmarking your blog now