Electronic Health Record Follow-Up Reduces Hospital Readmission

Using electronic health records can help reduce hospital readmissions and improve care with primary care and other physician specialists. Due to the Affordable Care Act, hospital committees and related programs are widespread with staff diligently working to reduce re-hospitalization rates of older adults or face escalating financial penalties.

Many studies are underway locally and nationally investigating a variety of methods to improve care.  Potential issues have been identified as:  drug interactions, lack of follow up with primary care physicians and lack of follow through on post care whether this be with home health, physical therapy, community based care, medical treatments or lab tests.

Primary Care Physician Visits Post Hospitalization Improve Health

A study completed by Gurwitz (2014) focusing on electronic communication between hospitals and the outpatient physician’s office did not demonstrate an increase in follow-up visits with a primary care physician or a reduction in the risk of re-hospitalization.

How it is possible that all of these practical and well thought out efforts failed to show improvement? It is possible that consumers and patients were not included in the research? 

A controlled trial by Gurwitz (2014) reports that the transition between the inpatient hospital setting and a return to home in the community represents a period of high risk for older adults living in the community. Notably, this transition often results in adverse events within three weeks of a hospital discharge.

Older Adults Are More Likely to Be Re-Hospitalized Within 30 Days of Returning Home

Those of us working in healthcare are aware that older adults are more likely to return to the hospital within a short period of time after being sent home. Yet how can we change the outcome of this transition so that our patients or clients do not return to the hospital within 30 days?

Is this aspect really within anyone’s control?

The Goal of Rehospitalization Research

One of the main goals of this trial was to implement an automated system to send information from the hospital to the patient’s primary care provider’s office. Information was sent relating to hospital discharge including medications, recommendations, lab tests, appointment reminders and information related to the individual care of the patient. 

As mentioned above, this communication failed to show progress in facilitating patient appointments with the primary care physician or decreasing re-hospitalization rates. Another question is were primary care physician offices consulted to make sure that when the information was transmitted there was a follow-up call to the patient?

Are Primary Care Physician Offices Too Busy?

For those of you with similar goals to reduce rehospitalizations of the elderly, this information may be helpful from a number of aspects.

• Questions were raised relative to the volume of information transmitted to primary care practices.
• While many offices now have patient portals, did the sheer volume of communication overwhelm physician office staff to the point that they failed to pay attention to alerts and information?
• Are primary care physician offices staffed with sufficient personnel to manage this information?
• Would this type of program be better served if patients were ranked by the highest likelihood of re-hospitalization, thus allowing critical information to be transmitted, rather than transmitting information on all patients who may be at low risk of re-hospitalization?
• If all information is sent, is there a way to flag patients by medical priority?

Admittedly this study did not involve the patient or family caregiver.  How might involving the patient and the patient’s family better support follow up medical appointments and lower re-hospitalization rates?

Is Patient Education a Solution?

Hospital, medical offices and medical providers continue to work diligently to solve the issue of re-hospitalization. However how much of the result lies in the control of the consumer — the patient?

Is the solution a combination of communication between medical providers and communication with those receiving care? Or is the solution turning the ship, so to speak, to educate consumers on their level of personal responsibility relative to their health and follow-up care at an earlier stage in life?

Should Consumers Bear the Cost of Not Following Medical Orders?

Like hospitals, should consumers be financially penalized by insurance companies for a lack of follow up care and for engaging in poor health habits? One of the problems is a lack of healthcare transparency.

Patients and consumers don’t know what medical care really costs. Would more cost transparency support a significant change in personal beliefs and habits about health that then might correspond to changes in the hospital and medical care system?

In my opinion the solution to re-hospitalization will not occur through one way penalties and communication. The solution is to hold the health care system and consumers equally accountable for reducing healthcare costs and improving outcomes.

Improving Health Literacy

That being said, many family caregivers, who are a critical part of this equation, possess low health literacy or may not be available to provide support. Should the healthcare system create a mechanism to improve communication specific to follow-up care after hospitalizations to ensure medical appointments with primary care physicians are scheduled?

Discussions continue about making healthcare more efficient and cost-effective. As long as the control to make this happen remains within the healthcare system and insurers and excludes patient education and engagement is this really possible?

Source:

Gurwitz, J., Field, T., Ogarek, J., Tjia, J., Cutrona S., Harrold, L., Gagne, S., Preusse, P., Donovan, J., Kanaan, A., Reed, G., Garber, L. (2014) An electronic health record – based intervention to increase follow-up office visits and decrease rehospitalization in older adults. JAGS 62:865-871. Doi: 10.1111/jgs.12798

©2014 Pamela D. Wilson, All Rights Reserved. 

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