An Early Look At A Four-State Initiative To Reduce Avoidable Hospital Readmissions

Abstract

Launched in 2009, the State Action on Avoidable Rehospitalizations initiative, known as STAAR, aims to reduce rates of avoidable rehospitalization in Massachusetts, Michigan, Ohio, and Washington by mobilizing state-level leadership to improve care transitions. With the program two years into its four-year cycle, 148 hospitals are working in partnership with more than 500 cross-continuum team partners. Although there are no publicly available data on whether the project is achieving its primary goal of reducing avoidable rehospitalizations, the effort has so far been successful in aligning numerous complementary initiatives within a state, developing statewide rehospitalization data reports, and mobilizing a sizable number of hospitals to work on reducing rehospitalizations. More than 90 percent of participating hospitals have formed teams to routinely review rehospitalizations with their community-based colleagues.

Pharmacist Advancement of Transitions of Care to Home (PATCH) Service

“…Although these methods have improved readmission rates and patient outcomes, it is unclear which intervention is most effective in reducing avoidable readmissions. [8][9][10][11][12]15 A common theme in each of these approaches is the importance of medication reconciliation and Transitions of Care to Home (PATCH) Service evidence-based medication management. As medication experts, pharmacists should serve as key members of the TOC team.…”

Hospital readmission rates in Medicare

“…These models encourage hospitals to save costs by reducing length of stay and shifting some of the care to post-acute care settings (e.g., skilled nursing facilities, home health care). In a similar initiative, The Commonwealth Fund supports the State Action on Avoidable Rehospitalizations (STAAR) in which hospitals join "cross-continuum teams" to coordinate with nursing homes, home health agencies, and physicians to educate patients, follow-up with patients after discharge, and work with universal discharge or transfer forms to reduce avoidable readmissions [29] .…”

Reassessing Post-Hospital Conditions of Section 3025 Hospital Readmissions Reduction Program in the Affordable Care Act

“…In addition to the high financial costs of re-hospitalization, readmissions is also associated with poor health care quality and causes detrimental health effects to the elderly, who are readmitted more often [8,9]. Post-hospital Syndrome is a condition, occurring within the first 30 days of hospital discharge, whereby the readmission medical diagnosis is different from the initial cause of hospitalization.…”