Reducing hospital readmissions: The perspective of the consumer

The Patient Protection and Affordable Care Act is concerned about the issue of hospital readmissions and has instituted financial penalties to discourage patient readmissions within 30 days of discharge. However, it is not clear whether financial penalties alone are adequate to ensure quality health care—especially for vulnerable elderly. The goal of providing quality care for all may require examining broader health care system factors that affect quality of care. Accordingly, the objective of this research was to understand the growing problem of elderly individuals with chronic health conditions being readmitted to a hospital for a health problem shortly after being discharged, in order to identify opportunities for intervention. Faculty at the Graduate School of Public Health (GSPH) at the University of Pittsburgh partnered with the Consumer Health Coalition (CHC), a non-profit, patient advocacy organization, to explore this issue. GSPH and CHC developed the Healthy Hospitals Initiative–a workgroup comprised of consumers, educators, and health professionals dedicated to reducing regional hospital readmissions by focusing on a patient-centered model of hospital discharge that emphasizes communication, comprehension and coordination of care. The members of the workgroup agreed to conduct some formative research in order to learn about the problems that older individuals encounter leaving a hospital—such as, medication management, scheduling follow-up appointments, and coordinating the exchange of information among various healthcare providers who are involved with the patient's healthcare. Six focus groups were held in the summer of 2012—three each with vulnerable seniors and caregivers of the elderly. Themes that emerged from the analysis include: the importance of the primary care physician, communication problems between providers and patients, communication problems among health care providers in hospital and community settings, medication issues and the lack of patient advocates. The analysis of the data has enabled us to characterize patient experiences that attend to specific individual and local environmental factors that affect the quality of care and provide opportunities for intervention.