A brand new study in this week’s New England Journal of Medicine, raises an alarm about the effectiveness of hospital stays for older adults in the US.
This study from Northwestern University found that there is a high readmission rate after hospital discharge, costing billions in additional health care dollars. Much of this stems from poor follow-up, with fewer than half of the patients seeing their physician in the first month after discharge. Another factor appears to be inadequate preparation for discharge, with patient education, explanation of medications and other information being given “too little, too late” in the hospital stay.
There is also inadequate palliative care for people with incurable disease, which leads to more hospital re-admissions. Finally, poor transitions and doctor-doctor communication play a role.
In all, about 1 of 5 Medicare recipients was readmitted within 30 days of discharge and over half within a year.
Care transitions are incredibly important. They are part of the current CMS “Ninth Scope of Work” project. It may be that the trend of the last few decades to save dollars through shortened hospital stays has gone too far, but longer stays can lead to more infections, delirium and other complications.
Clearly, much more needs to be done proactively to insure that acute care also provides a more comprehensive system of post-hospital support.