Cause-effect and Intervention Strategy for Re-hospitalization
Re-hospitalization refers to the occasions when the patients are discharged from the hospital but return after some time due to the deterioration of their health. Re-hospitalization lowers the quality of life for the patients, has high financial implications and harms the health of the individuals, which can lead to cases of death.
Purpose of the Study
The primary purpose of the study is to define the financial and health implications of re-hospitalization and intervention strategies for patients. The effects of re-hospitalization on individuals include the financial costs and the health risks involved. The study aims to find efficient intervention strategies that will reduce re-hospitalization rates for the financial and health well-being of the patients.
Significance of the Study
The study is important due to various reasons. First, it will help reduce the effects of re-hospitalization on patients. Moreover, it traumatizes people since the state of their health requires the execution of many tests for proper diagnosis. In some cases, the treatment involves surgery, which is traumatic to the body. Constant re-hospitalization deteriorates patients’ health in the long run. In addition, it influences the finances of individuals because they need to pay hospital bills (Jencks, Williams, and Coleman, 2009). Another reason is that this study will help to protect hospital staff from malpractice. Most re-hospitalization cases are caused by early discharge (Berenson, Paulus, and Kalman, 2012).
Therefore, hospital staff can face malpractice accusations, such as patient neglect if premature discharge led to re-hospitalization. In addition, this study is significant as it will help to ensure the maximal use of the hospital facilities. When the patients are re-hospitalized due to avoidable reasons, they require space, time, and staff that would be otherwise useful for other individuals who need the facilities and resources. For example, re-hospitalized patients occupy beds that would be otherwise occupied by other people if they were not re-hospitalized. Therefore, the prevention of such cases saves time, energy, and resources.
Statement of the Research Problem
Re-hospitalization of the patients results in putting a toll on the patient's health status and finances. It is necessary to take measures to ensure the complete recovery of the patients in case they are discharged. Without full recovery, the individuals may develop complications that can result in death, financial derailment, and general health deterioration. Moreover, the patients who are adversely affected by re-hospitalization are prone to malpractice lawsuits, which will influence both hospital facilities and staff. Therefore, preventing re-hospitalization is essential to ensure that the finances and health of the patients will not be affected to prevent problems such as lawsuits, misuse of facilities, and wastage of time. As a result, credible intervention strategies are necessary to mitigate the occurrence of patients’ re-admission after discharge from the hospital.
Literature Review
Regarding the issue of re-hospitalization, the concerns for the researchers include the existing rates of re-hospitalization, corresponding implications, and intervention strategies. Vashi et al., (2013) raise the issue of the relationship between re-hospitalization rates and the quality as well as the effectiveness of inpatient medical care in hospitals. Therefore, high rates of re-hospitalization of patients indicate poor quality of healthcare services provided by the hospitals. Berenson, Paulus, and Kalman (2012) state that the causes of re-hospitalizations include premature discharge, complications after discharge, infections acquired from the hospitals, poor planning for care transitions, failure to coordinate and reconcile medication, and inadequate communication. According to Boutwell and Hwu (2009), it is possible to prevent most cases of re-hospitalization because the causes are avoidable. Intervention strategies can be classified into pre and post-discharge interventions, which include medication reconciliation, scheduling of follow-up appointments, follow-up telephone calls as well as hotlines that are activated for discharged patients respectively (Hansen et al., 2011). Boutwell and Hwu (2009) recommend various interventions, such as home care visits, improved discharge processes, and patient education. The study proposed the listed interventions since the implementation of the interventions is a simple and easy task. Prolonged inactivity is likely to cause weakness of muscle and consequent deterioration in the quality of overall health status. Physical therapists are trained to handle physical movement necessary for health improvement. Consequently, physical therapists can be instrumental in ensuring that patients’ physical component is strong, thus reducing the chances of re-hospitalization (Falvey et al., 2016). Bradley et al. studied interventions and compared their effectiveness in reducing the re-admission rate. They defined that scheduled outpatient appointments for discharged individuals were effective in eliminating the need for re-admission (Bradley et al., 2014). Other studies have indicated the need to introduce multi-faceted intervention strategies that cover inpatient, outpatient, and home care to reduce the occurrence of re-admissions (Kripalani et al., 2014). Multifaceted interventions integrate the use of pre-discharge and post-discharge interventions for wholesome patient care.
The purpose of an article by Berenson, Paulus, and Kalman (2012) is to analyze the issue of re-hospitalization from an economic perspective. It is a descriptive article, which uses secondary information. The paper reviews the causes and consequences of patient re-hospitalization and provides recommendations regarding the possible solution. The article states that the main cause of high re-hospitalization is the revenue collected by the hospitals when their beds are at full capacity. According to the information provided by the hospitals, data from the Medicare program is used for analysis. It includes the rates of patient re-hospitalization and the accrued costs respectively. Regarding the solutions recommended in the article, they include financial penalties for hospitals with a high rate of avoidable readmissions. Secondly, the article recommends the use of a program, when Medicare can offer the hospitals high payments for ailments that are likely to have re-admissions. However, the high payments have to be less than the projected costs of admissions and consequent re-admissions. Consequently, a significant amount of money will be saved due to spending on re-admissions. The strengths of this article include the exact financial cause of re-hospitalization and practical recommendations. However, the weaknesses include the demography used in the research. The research involves a limited number of people, which can be unrepresentative of all Medicare patients. This article provides an intervention that can help reduce patient re-hospitalization, thus relating to this study.
The purpose of “Outcomes after Re-hospitalization at the Same Hospital or a Different Hospital Following Critical Illness” is to showcase the effect caused by the lack of care continuity from the primary hospital on mortality for intensive care unit (ICU) patients (Hua et al.,2017). There is a lack of care continuity when the patients are re-hospitalized in different hospitals, where they further received their initial treatment. The article is descriptive and uses secondary data collected by the New York Statewide Planning and Research Cooperative System to compare mortality rates for the patients who are re-hospitalized in their primary care facilities and those in other hospitals. The results of the study show that there is a 2% increase in the number of individuals who are re-hospitalized in the facilities that failed to provide primary care. Therefore, the article recommends continuity of care by the hospitals that provide initial treatment to ICU patients. However, the research is limited in scope as it focuses on the effects of fragmented care on ICU patients. There is a lack of comparison with the patients who receive different treatments, such as major or minor surgeries for comparison purposes. The research is relevant to this study since it emphasizes the importance of continued care for patients treated with major procedures to prevent high mortality rates.
The article by Jencks, Williams and Coleman (2009) investigates the costs of patient re-hospitalization incurred by Medicare. In compliance with the first observation made from the data, there was a high rate of re-hospitalization for the individuals using Medicare within 30 or 60 days after discharge. Consequently, 19.6% and 34% of Medicare beneficiaries were re-admitted thirty days and ninety days after discharge respectively. Moreover, 51.5% and 67.1% of the discharged patients after surgery and with corresponding medical conditions died or were re-admitted in the first year after discharge. However, 50.2% of the patients who were re-hospitalized in 30 days did not have bills indicating visits to physicians between the time after their discharge and re-admission. In 2004, the cost of unplanned re-hospitalizations on Medicare amounted to 17.4 billion US Dollars. According to the research, it is possible to conclude that there are two major effects of re-hospitalization. The first effect is the cost implications, while the second effect is the mortality rate associated with re-admissions to the hospital. The research is descriptive as it surveys data provided by Medicare from their insurance claims. The research strongly proves that re-hospitalization costs are high. However, it specifically focuses on Medicare patients, thus lacking information regarding the expenses that uninsured individuals incur due to their readmission to the hospital. This research relates to the study as it indicates the adverse effects of re-hospitalization.
An article by Favley et al. (2016) seeks to contribute to the growing database of intervention strategies that reduce the rate of readmission. The study notes the lack of information regarding the effect of services from a primary caregiver who is a physical therapist. Physical therapists impact the strength, gait speed, and daily activities of the patients. The study focused on the impact of physical therapy on older adults who were within intervention transition models. It used an exploratory design as there lacks lacksearch on the input of physical therapists in transitional interventions. Moreover, the study used information from the previous literature related to the subject, while most of the content focused on suggesting the ways, due to which physical therapists can positively impact the recovery of discharged patients. These respective measures included the following: coordinating care among different caregivers, advance care planning, seeking help from the community and home supports, patient education on self-management, medication safety, clarity of information in discharge summaries, and discharge planning. The study concluded by stating the benefits of incorporating physical wellness for discharged patients in ensuring that they are not re-admitted. The study was limited because it focused on the benefits of physical therapy for older patients who were discharged. It was relevant to the topic of interest because it showed that different caregivers can be involved optimally in the activities that ensure low re-hospitalization rates among discharged patients.
Theoretical Framework
The Diffusion of Innovation Theory applies to the research topic of interest. This theory was proposed by E.M. Rogers in the year 1962 (Grebel, 2011). It explains how a product or an idea diffuses through a population over time resulting in the adoption of new products, ideas, or behavior. The theory focuses on the conditions that influence the chances of a population adopting a new behavior, product, or idea. It assumes that there are different groups of adopters who have different personalities. These groups are innovators, early adopters, early majority, late majority, and laggards. Innovators are a small number of imaginative people who develop new ideas, products, and behavior. The likelihood of innovators adopting their new ideas, products, and behavior is extremely high. Early adopters are investors who accommodate the innovations when they notice the first benefits. The early majority involves risk-averse and cost-sensitive people who adopt the innovation, without seeing the benefits but hearing positive comments from the early adopters. The late majority are conservative individuals who hate risk and do not accept innovations. They resist innovation on the advice and fear laggards. Laggards are people who see the risks in adopting innovations.
According to the Diffusion of Innovation Theory, it is necessary to view positively intervention strategies of their observability, relative advantage, trialability, complexity, and compatibility. The interventions that may arise from this study involve behavioral change by the practitioners, other caregivers, and patients. Consequently, practitioners have to view them as a way of promoting the health of their patients. Additionally, they should consider the fact that the benefits of interventions prevail over the costs of their implementation. Moreover, they should be flexible about the time and labor consumption to enable practicing practitioners to integrate the interventions without compromising their capacity. In addition, the measures have to be compatible with the existing standards of operations used by the practitioners. The complexity of the interventions should be minimal to increase their rate, which the practitioners integrate into their daily activities. Technologies offer an advantage in ensuring the compatibility of activities, such as follow-up check-ups. The intervention proposals have to be measurable and observable. Consequently, interested scholars can study them, and the stakeholders interested in implementing them can make knowledge-based decisions. The patients involved in the interventions have to be convinced of the beneficial characteristics of the interventions, as compared to traditional discharge, as the interventions may require more costs due to the home-based healthcare and inclusion of caregivers, such as physical therapists. In addition to nurses, these caregivers should be confident about the improvement of their patient's health. Moreover, they should ensure the implementation of intervention strategies aimed at reducing re-hospitalization rates.
Definition of Variables
The independent variables that will be involved in the study include the medical care administered to the patients. The dependent variables include the outcomes of the treatment regarding health status and financial implications.
Research Questions
Impact of post-discharge intervention strategies on the health and cost implications on patients
Impact of a multifaceted intervention on the health and cost implications on patients
Research Design
The overall design is quantitative as the study criticizes results and conclusions attained from the conducted experiments, such as clinical trials. The study is descriptive because it surveys data obtained from different sources, such as the Medicare database, as well as analyzes results and conclusions from case studies that have already been executed. Different researches answer all the questions raised in this study, which is the reason for using these designs. The research will involve taking a sample of hospitals, in which the different recommended interventions will be considered as well as another sample, which will omit provided recommendations. Further, it will be necessary to compare the re-hospitalization rates between the two samples and make corresponding conclusions based on the obtained results. These research designs will help the study to attain accurate and reliable outcomes because due to its focus on real patients.
Assumptions
The advantages related to the descriptive design of the research are the following: natural observation of the patients, application of the collected information collected in other research, as well as the fact that the information gathered is deep and rich. Among the disadvantages, it is possible to specify the following: the patients may have failed to be completely honest, lack confidentiality, the researchers may be biased, and the findings are open to interpretation.
Sampling Method
The method of the study will be probability sampling. Therefore, the management of the hospitals will be aware of their possible participation in the study. These corresponding facilities will be notified of the study, thus having prior knowledge about the research. Different hospitals will implement various interventions. For example, some facilities will improve their discharge process, while others will provide outpatient follow-up appointments. Moreover, some hospitals will provide remote monitoring, others will ensure transition care, provide home-care visits, implement all the interventions, and there will be those, which will refuse to execute any interventions. It will create a wide pool, which will provide sufficient information for attaining reliable results.
Data Collection
Data will be collected from both patients and hospitals. The hospitals will provide information in the reports demonstrating the influence of the implemented interventions on their re-hospitalization rates. The patients will provide reports on the status of their health and finances after discharge. The staff will also help to monitor the patient's progress and give weekly reports for one month after the first week. The reason is that the majority of re-hospitalization cases occur within the first thirty days after discharge from the hospital. During the first week, the risk of re-hospitalization is extremely high because the patients are still in recovery. Therefore, the hospital staff will have to monitor the patients closely to note their progress.
Ethical Considerations
The individuals involved will be informed of the risks related to the research study. However, their rights, health, and finances will be protected to ensure that they are not negatively affected.
Instruments of Data Collection
The instruments that will be used for the research are hospital equipment. It will help to monitor the health of discharged patients to determine whether causes for re-hospitalization are occurring. The involved staff will be in charge of monitoring the patients who choose to participate in the study. Home visits will require measuring the health indicators of the patients, administering interview questions, and observing the health status of the participants. Other instruments include questionnaires that will be aimed at attaining information from both hospital staff and patients. The individuals will provide information showing how the experience of interventions has affected them through interviews and telephone conversations. Hospital staff will state easy and difficult tasks related to the implementation of the interventions by filling out questionnaires.
Data Analysis
The data obtained will be analyzed using statistical methods to compare different aspects of the results. The reports provided by both hospital staff and the patients on patient progress will be analyzed and conclusions will be drawn. It will include the effects of the intervention implemented on the patient’s health and financial status. Further, these conclusions will be compared to the financial and health effects of re-hospitalization expressed by patients who faced readmission. The re-hospitalization rates of the different hospitals involved will be compared to each other and the existing readmission rates in other facilities. Then, it will be necessary to conclude, stating which interventions are the most appropriate for reducing rates of re-hospitalization. The information obtained from the questionnaires will be analyzed and the experience of implementing the interventions will be assessed accordingly. Depending on the response of the involved individuals, improvements in implementation will require consideration. The results and conclusions will finally be compiled into a report containing recommendations that will be presumably implemented in the hospitals to help reduce re-hospitalization rates.