(P47) Reduction in Hospitalization, A Formidable Goal!

Objective/Aim: Hospital readmission of nursing home patients continue to pose a safety and quality of life as well as a cost issue. The purpose of this initiative is to promote evidence based strategies in reducing avoidable hospitalizations.

Background: Nursing home residents continue to be at the highest risk for hospitalizations given their comorbidities along with age expected cognitive and functional decline . It is estimated that 20% were readmitted to the hospital within 30 days of discharge. Most of these hospitalizations were unplanned and costly. Data has shown that most of them could be preventable such as Congestive Heart Failure, Respiratory infection, Urinary tract infection and Sepsis. We, at St. Camillus Rehabilitation in Syracuse, NY are faced with the same formidable issue and have collectively worked hard to reduce our avoidable hospitalizations.

Quality Improvement

Methods: St. Camillus is a non-profit, 282 bed skilled nursing facility in Syracuse, NY. We used a multifaceted root cause analysis procedure to identify key drivers of hospital transfers and then implement performance improvement strategies to impact root causes and produce better outcomes. Baseline data when we first engaged with the initiative indicated that our adjusted all payer re-hospitalization rate of 23.5% was significantly higher than the benchmark rate of 16%. Long-term hospitalization rates (10.7%) were also in excess of benchmark (9.5%). The facility convened an interdisciplinary team in October 2021, to begin studying the issue and to develop performance improvement strategies. The rehospitalization rate spiked unfavorably in June 2022, where we experienced a rate of 31.5%. The team was able to identify key root causes and implement meaningful performance improvement strategies which were effective in driving down our rate of hospital transfers and re-hospitalizations. Outcomes were monitored by reviewing analytic data on Medicare and all payer 30 day re-hospitalization rates, as well as claim based data and a long-stay rehospitalization metric.

Results: Following implementation of the improvement strategies, the facility’s 30 day re-hospitalization rate improved significantly in July to (to 17.2%) which came close to benchmark rates. With further implementation of performance improvement strategies, the facility’s re-hospitalization rates improved to better than benchmark for August (13.4%) and September (15.1%). Outcomes on the long-term re-hospitalization metric also improved to better than benchmark (ranging 10.5-8%). This reduction in re-hospitalization rates has helped to optimize care for patients, stabilize the facility’s occupancy and improved relationships with the hospitals and key stakeholders.

Conclusions: Case reviews and root cause analysis and proactive approaches such as Palliative Care discussions along with interdisciplinary care coordination are critical in reducing avoidable hospitalizations.