Understanding the root causes of patient rebounding

No health care provider ever wants to see a patient return to the ER or their office due to complications from a prior illness. But emergency room rebounding and hospital readmissions happen, and it’s up to healthcare leaders to understand how and why to fix the problem.

Finding the root causes of patient rebounding is no easy task. Hill Physicians Medical Group of San Ramon, Calif., started by asking some key questions:

  1. What occurred during the patient’s hospital course?
  2. How was the patient managing his/her conditions in the period prior to hospitalization?
  3. Was the patient visiting primary care or specialty physicians regularly?
  4. Was the patient taking medications as prescribed?

Hill Physicians then conducted a root-cause analysis roundtable with its ACO hospital partners for a specific population. By discussing individual readmissions, Hill Physicians and the hospital system determined that clinical and non-clinical factors both play roles in patient rebounding.Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth

Hill Physicians found both clinical and non-clinical causes of patient rebounding. On the clinical side, patients may not follow up with their physician after leaving the hospital. They may not follow medication regimens. Patients also may be sicker with more care needs. Non-clinical causes may be impacted by a patient’s substandard medical literacy, his or her lack of a support structure, or information is not provided to their care provider in a timely manner.

Hill Physicians and its ACO partners also talked with patients who had been readmitted to record their opinions as to what caused them to return to the hospital, what they understood and didn’t understand about discharge instructions, and what they might have done differently themselves to achieve a different outcome.

These discussions led Hill to modify both its inpatient and outpatient clinical and system processes to decrease avoidable readmissions. By adopting practices such as appointment making, non-traditional home health visits, and other interventions, Hill Physicians was able to decrease its 30-day commercial readmission percentage by 20 percent in one year.

Knowing what causes rebounding and readmissions is one step. In our next post, we’ll discuss how provider-based care transition programs impact readmissions.

If you want to get the full story now, please download the white paper: “Preventing Patient Rebound: Value-based Care Organizations Should Focus on More Than Just Readmissions.”

Miles Snowden, MD, Chief Medical Officer, Optum

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