So you want to reduce hospital readmissions. You introduce some quality improvement programs with that goal in mind. Will it work? Maybe, maybe not says a study carried in JAMA Internal Medicine. (JAMA Int. Med. Article) The authors conducted a meta-review and analysis of research on interventions designed to reduce hospital readmissions. They identified 50 studies from around the world. The researchers were particularly interested in whether the interventions produced net savings, which were defined as a reduction in total costs to the health system, not the effect on particular providers or payers. The interventions were grouped into five main types–assess patient risks and needs; engage patients and caregivers; reconcile medications, connect patients with their usual source of care; and supplement that usual source of care. Almost every intervention involved supplementing usual care, and medication reconciliation was the least included tactic, but most of the studied interventions involved most of the tactics. Half the studies involved only patients with heart failure, who account for a very high proportion of hospital readmissions. The majority of the studies were randomized control trials. Forty-four featured cost analyses, the remaining six looked at cost-effectiveness or considered cost-benefit tradeoffs.
Looking at the heart failure interventions, there were net savings in most cases, but net losses in five of the studies. For the general population interventions, results were more mixed, with some having net savings to the system and some increasing overall costs. Across all studies, the average net savings per heart failure patient was $972, which did not reach significance, and for the general population there was actually a net cost increase of an non-significant $169. For heart failure, across all studies there was about a 12% reduction in the risk of readmission. For the general population studies, the reduction in risk of readmission was only about 6.3%. Among types of interventions, there were not clear results, but it appears that engaging patients and caregivers may have the greatest effect for the general population, but not the heart-failure subcategory. While it is easy to be disappointed that there really aren’t net savings; if reducing readmissions is an important quality outcome, we should be willing to spend for that improvement, and some of these interventions did create readmission reductions.