Care Strategies for Reducing Hospital Readmissions Using Stochastic Programming

Abstract

A hospital readmission occurs when a patient has an unplanned admission to a hospital within a specific time period of discharge from an earlier or initial hospital stay. Preventable readmissions have turned into a critical challenge for the healthcare system globally, and hospitals seek care strategies that reduce the readmission burden. Some countries have developed hospital readmission reduction policies, and in some cases, these policies impose financial penalties for hospitals with high readmission rates. Decision models are needed to help hospitals identify care strategies that avoid financial penalties, yet maintain balance among quality of care, the cost of care, and the hospital’s readmission reduction goals. We develop a multi-condition care strategy model to help hospitals prioritize treatment plans and allocate resources. The stochastic programming model has probabilistic constraints to control the expected readmission probability for a set of patients. The model determines which care strategies will be the most cost-effective and the extent to which resources should be allocated to those initiatives to reach the desired readmission reduction targets and maintain high quality of care. A sensitivity analysis was conducted to explore the value of the model for low- and high-performing hospitals and multiple health conditions. Model outputs are valuable to hospitals as they examine the expected cost of hitting its target and the expected improvement to its readmission rates.

Financial and Safety Impact of Simulation-based Clinical Systems Testing on Pediatric Trauma Center Transitions

“…The degree to which readmissions result in direct incremental costs to the institution is difficult to quantify, but they are likely to produce disproportionate financial losses for children's hospitals. [22][23][24][25] Unplanned hospital readmissions occur after 5%−25% of admissions for trauma and are associated with in-hospital adverse events. [26][27][28] Simulation-based quality improvement initiatives are associated with reductions in readmissions from 12% to 50% below the baseline readmission rate.…”

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

“…Over 20% of all patients in the United States are readmitted within 30 days after discharge, resulting in an increased risk of nosocomial infection and injury as well as significant financial burden for hospital systems (34,35). Investigations into predictive methods to avoid readmission have flourished globally, emphasizing the importance of this outcome (36)(37)(38)(39).…”

Effectiveness of Transitional Care Program among High-Risk Discharged Patients: A Quasi-Experimental Study on Saving Costs, Post-Discharge Readmissions and Emergency Department Visits

“…Such readmissions cause a burden on healthcare resources and increase the cost of readmissions [1]. Hospital readmission is defined as the unplanned admission of a patient to a hospital within a specific discharge period after an initial stay at the hospital [2]. For instance, readmission to the hospital within 30 days of discharge accounts for nearly 20% of hospitalized older Medicare patients [3].…”

“…In 2015, the Center for Medicare and Medicaid Services (CMS) announced financial penalties of up to 1% of Medicare reimbursements to more than 2000 hospitals due to high readmission rates [5]. The penalty applies to the following six health conditions with a high 30-day readmission rate: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PNE), chronic obstructive pulmonary disease (COPD), total hip/knee arthroplasty (HK), and coronary artery bypass graft (CABG) surgeries [2].…”