Reducing Seven-Day Hospital Readmissions in Arizona

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The Hospital Readmissions Reduction Program (HRRP) is a pay-for-performance program that lowers payments to Inpatient Prospective Payment System (IPPS) hospitals with too many readmissions. The program, established in 2010, gives hospitals a strong financial incentive to improve their communication and care coordination efforts and work better with patients and caregivers on post-discharge planning.

Upon entering the sixth year of the HRRP, Arizona hospitals shared with Health Services Advisory Group (HSAG)—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Arizona, California, Florida, Ohio and the U.S. Virgin Islands—that they had made improvements with 30-day readmissions but determined that many of them were primarily due to factors beyond the hospitals’ control.

Despite this progress, HSAG recognized that of those patients readmitted within 30 days, the largest percentage, over 36 percent, were readmitted within the first seven days after hospital discharge. According to HSAG, seven-day readmissions are a stronger indicator of quality of care during care transitions -- and of process failures -- than the 30-day metric.

During a series of site visits with hospital leadership where quarterly readmission reports were reviewed, HSAG pointed out the high seven-day readmission volume and recommended that the seven-day rate be considered when measuring success.

Hospital leadership agreed with the recommendation; thus, HSAG started working with Arizona hospitals and other stakeholders to develop a seven-day readmission reduction plan as one of the strategies to reduce avoidable readmissions.

Results:

While working with HSAG, hospitals made significant improvements to their 30-day readmissions rate and, as a result, did not see readmissions as a matter of concern. Some hospitals indicated that readmissions remained a focus but were no longer a system-level priority. However, when HSAG redirected hospitals' focus to seven-day readmissions, providers became re-engaged in readmission work and made reducing them a top priority.

Additionally, HSAG developed a seven-day intervention bundle and shared it with providers across the care spectrum in the states where they worked. The bundle included an organizational assessment; strategy tree document; daily readmission checklist and audit tool for daily huddles; huddle board guidelines and instructions to keep the issue visible; a seven-day audit tool; and a patient interview tool.