But there are other, non-clinical factors that also lead to readmissions. The causes can be grouped into three main categories:
Patients’ medical literacy
According to the National Network of Libraries of Medicine, the National Assessment of Adult Literacy shows only 12 percent of the U.S. population has a proficient health literacy level.
That means patients may lack the reading, listening and decision-making skills to follow directions for discharge, prescription use, consent forms and more.
Lack of support structure
Some patients rebound to hospitals or emergency departments because they don’t have a support network to help them follow their post-discharge program.
Cathryn Kelly, a manager of population health with Lehigh Valley Health Network, says high-risk patients may be lacking social services. They may be uninsured or underinsured. They may not have access to food.
“For an individual to focus on their health care, their everyday needs really need to be met,” says Kelly.
Lack of timely information
Siloed technology solutions and a lack of interoperability standards continue to make it hard to share the information across inpatient and outpatient settings.
Addressing these factors requires a level of patient engagement and support that is not yet prevalent in the current health care system. But it is a key component of population health management and the transition to value-based care.
The latest #5in5 episode from Optum Provider explains how Lehigh Valley Health Network is using data and analytics to treat the whole patient and manage some of these non-clinical factors.
The episode features Kelly answering five questions in five minutes on topics including the use of data across departments and using data to identify high-risk patients and target resources.
About the Author:
Leslie Cozatt currently serves as Director of Marketing, Optum Provider – Thought Leadership and Content Strategy. She directs the development of content that spotlights the role of data analytics in healthcare – specifically the transition to value-based care, risk management and population health management. She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M. Leslie attended the University of Minnesota and graduated from Wellington College with a BS in International Business & Communication