Blog | Thursday, January 24, 2013

QD: News Every Day--Easing transitions from hospital may lower rehospitalizations

Quality initiative related to transitions of care were associated with lower rehospitalization rates, but not with reductions of rehospitalizations as a percentage of hospital discharges, which is the more frequently used measure, a study found.

Researchers examined results of 14 intervention communities and 50 comparison communities from before (2006-2008) and during (2009-2010) implementing the quality initiatives.

Results appeared online Jan. 22 at JAMA.

The researchers found that the 14 intervention communities had an average reduction of 5.70% in rehospitalizations per 1,000 and of 5.74% in hospitalizations per 1,000 for fee-for-service Medicare beneficiaries over the 2-year intervention period. During the same period, the 50 comparison communities had a 2.05% mean reduction in rehospitalizations and a 3.17% mean reduction in hospitalizations.

Researchers noted that rehospitalizations as a percentage of hospital discharges did not change during the study period, with a difference of 0.06% in the intervention communities and -0.16% in the comparison communities.

And editorial summarized this and two other related studies, and noted that hospitalists, emergency physicians and others have long seen patient care become spread among an increasing number of subspecialists.

"This has likely been driven, at least in part, by the marked expansion in the number of subspecialists, who now outnumber primary care physicians by about 2 to 1," they wrote. "Medicare beneficiaries and their families must navigate seeing a median [midpoint] of 2 primary care physicians and 5 specialists during a 2-year period, and about one-third change their assigned physician from one year to another. This fragmentation escalates as patients approach the end of their lives with numerous physicians involved in a patient's care."