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Introduction

Health care readmission tends to be the episode when the patient who had been previously discharged from the health facility is admitted again within a  particular tie interval. The rates of readmission have been used recently in the health care services research as a tool that is used to measure the quality of health care services. The health care readmission rates were included in the reimbursement decision for the Centers for Medicare and Medicaid Services as a segment of the patient protection and affordable care Act of the year 2010, which focuses on punishing health care systems which have high and expected rates of readmission through the use of the  Hospital Readmission Reduction Program. Following the introduction of this penalty, several other programs have been introduced to minimize the health care readmission rate. Some of the programs that have been developed are The Community Based Care Transition Program, Independence At Home Demonstration Program as well as the Bundled Payments for Care Improvement initiative. Also, the health care facility and programs tend to use different time frames to measure the rate of readmission, and the ordinary time frame used is within 30 days of discharge.   This research paper will how health care readmission may impact a health facility both negatively when it is high and decisive when it is low (Al-Amin, 2016). Health care readmission has contributed to increased cost in health care provision and a the same time it lowers the quality and patient satisfaction on the health care services provided to him or her.

Brief introduction to the purpose of the study

The health facility readmission has continued to increase the cost of health care in the United States. Health care readmission is often regarded to be an essential tool for measuring the quality of the health care services that particular health care services provider. It is not quite easy to measure quality based on readmission rate of the patient, but it tends to make more sense that a patient tends to be readmitted because the services he was provided with were not of high quality hence not being able to meet his or her health needs(Lackey, 2015). Often readmission is caused by adverse outcomes from a previous treatment. The primary purpose of this study is to determine if the rate of hospital readmission tends to be an accurate measure of quality in the health sector.

Results

            Upon conducting the research, the research team was able to identify two major factors that contributed to the increase in the rate of readmission in health care facilities in the  United States. The two main factors that were identified were poor information use and management and poor communication pattern.

Poor information use and management

            The findings showed that during the period of admission, information collected tends to be lightly reviewed. Hence the decision made based on the information attained tends to not appropriately support the patient’s health, which leads to readmission within 30 days of discharge(Axon & Williams, 2011). It was also noted that upon readmission, the health providers often reviewed the information critically from the past patient’s health records to provide the patient with satisfactory health care service. It was noted that when the health care providers reviewed the patient’s past medical record, they were able to develop valid decision in regards to the improvement of the patient’s health, hence reducing the rate of readmission. Often health facilities tend to use the previous information to develop a clinical decision and following on how the information is used and managed may significantly determine the diagnosis as well as the treatment approach a patient isprovided with.

During admission, the patient should provide his orher past medical information to assist the health practitioners being able to develop accurate clinical decision regarding their health issues. The health care providers need to create a well-documented treatment plan to be able to understand what triggered the readmission and be able to fix the issue(Ballard-Hernandez, 2010). The health facilities need to use advanced technology to record the medical activities and the treatment strategies that they have offered to the patient in order to have an easier way to develop a follow-up.

Poor communication pattern

             Communication plays a significant role in ensuring that a patient is provided with quality and satisfactory care. For instance, through effective communication approach standard coordinating care with multiple settings and providers, involving the patient and family caregivers in the plan of care as well as conducting post-discharge follow-up phone calls may be developed hence minimizing the rate of hospital readmission which in turn improves the quality of health care and reduces the health care cost(Bottle, Aylin, & Bell, 2013). Following the findings on the research conducted, it was noted that the communication pattern between the health care providers and health care providers to patients being discharged contributed significantly to the increase in the rate of rehospitalization. Most of the patients who participated in the research asserted that they did not clearly understand how transitional care worked; hence, they were not able to precisely follow the doctors prescription.

Most of the patient provided recommendations that the health care providers should develop a discharge training program which enlightened the patients on how to take care of themselves while they are at home to reduce readmission as well as the health care cost. Also, communication between the health care providers was found to contribute to the increase in the rate of readmission majorly(Bottle, Aylin, & Bell, 2013). Some of the participants of the research who were health care providers asserted that poor communication pattern was also a great contributor to misdiagnosis. They asserted that excellent communication among the work teams greatly impacted the health outcomebecause they would be able to discuss the essential aspects regarding the patient’s health and be able to develop a strong clinical decision. They asserted despite understanding the patient’s situation from his or her past medical records, and it was essential for the health care providers to discuss on the best treatment approach that the patient would be provided by focusing on quality and satisfying the needs of the patient.

Discussion

            The study aimed at understanding if the rate of readmissions in a health facility may be used to determine the type of quality the health facility offers. The findings asserted that the patient’s past medical record plays a significant role to determine the clinical decision that is to be made. The health providers to always review the patient’s past information record to be able to understand the health status of the patient to avoid readmission. On the other hand, communication plays a critical role in the patient’s health provision. Thus,  the health care providers need to come together, and it is through communication; they can be able to develop an effective treatment plan. The findings of the research have provided proof that the rate of readmission in a health care facility may be used to determine if the health services provided are of high quality.

Limitations of the Study

            Despite including patients and health care providers in the research,the study mainly focused on the activities that contribute to the increase of readmission rate and how the health care providers contributed to these aspects. The research only focused on asking the patients how they felt readmission was impacted them.

Study  implications and future works

            The findings attained from the study created a room for further investigation on the issue of readmission by focusing on the behavior as well as thinking among the health providers. The investigation would assist the researchers in understanding how the health care provider’s thinking and behavior impact the patient care decision and the treatment approach.

Conclusion

The results attained from the research showed that poor use and management of patient information and poor communication pattern is a major contributor of increased high readmission rate in the health sector.  The finding also asserted that health care providers tend to become more conservative when they are found in the situation of patient readmission. Generally, the findings of the research have provided proof that the rate of readmission in a health care facility may be used to determine if the health services provided are of high quality.

References

Al-Amin, M. (2016). Hospital characteristics and 30-day all-cause readmission rates. Journal of Hospital Medicine, 11(10), 682-687. doi:10.1002/jhm.2606

Axon, R. N., & Williams, M. V. (2011). Hospital Readmission as an Accountability Measure. JAMA, 305(5), 504. doi:10.1001/jama.2011.72

Ballard-Hernandez, J. (2010). Nurse practitioners improving the transition from hospital to home and reducing acute care readmission rates in heart failure patients. Heart & Lung, 39(4), 365-366. doi:10.1016/j.hrtlng.2010.05.031

Bottle, A., Aylin, P., & Bell, D. (2013). Predictors of Readmission in Heart Failure Patients Vary by Cause of Readmission: Hospital-Level Cause-Specific Readmission Rates Show No Correlation. 2013 IEEE International Conference on Healthcare Informatics. doi:10.1109/ichi.2013.88

Lackey, T. L. (2015). How transitional care can be the answer to reducing hospital readmission. Heart & Lung, 44(6), 557-558. doi:10.1016/j.hrtlng.2015.10.035

 
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Designing and Implementation

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Designing and Implementation

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Designing and Implementation

Brief Literature review

            Preventable hospitable readmission is a significant and growing concern in the United States healthcare sector. The issue of hospital readmission represents about 20% of the hospitalization, and the patient incurs about $18- $25 billion of unnecessary cost. The Medicare reimbursement financial incentives and the National quality initiatives have made significant efforts which are aimed at reducing the rate of readmission following several strategies and interventions (Al-Amin, 2016). 

The rate of readmission for the Medicaid and  Medicare beneficiaries has continued to increase hence impacting the United States health care provision negatively.  The primary reason for the numerous readmission in the health care facilities is contributed by medical errors, failure of the treatment plan, defects in care, shortcomings in preparing the patients and their families the health care outside the health facility(Lackey, 2015). The main reason for this frequent readmission is the inability to create discharge processes which are of quality standard, minimal preparation of patients and families for the discharge, poor communication and minimum education to he patients in regards to the essentialness of the treatment approach.  Several studies tend to link the increasing rate of readmission with inadequate follow up by the primary care providers and other concerned healthcare facilities

As the cost of health care continues to increase and the health care reimbursement being dependent on the length of stay and satisfaction of the patient, the rate of hospital readmission has become a tool that used to measure the quality of patient care a health facility provides(Axon & Williams, 2011). Despite being a tool of measuring quality, the rate of hospital readmission also tends to impact the well being of the patient. The research topic tends to have a public significance due to the health disparities for those with high risks for readmission.

The knowledge of nurses plays a significant role in the development of approaches that may be used to develop a follow as well as continuous care to limit readmission, promote practical usage of resources and also be able to reduce cost. Currently, health facilitates are often engaging their patients with health training before discharging them to reduce the rate of readmission. Nurses play a significant role in ensuring that quality health care services have been administered to the patients. A health facility that tends to establish a skilled nursing unit can improve health care coordination as well as quality(Ballard-Hernandez, 2010). Following efficient communication, planning, education as well as coordination the nurses and the Nurse case Managers may be able to reduce hospital readmission effectively.

            Also, communication may improve the collaboration between the Professional Care Providers, the home health care agencies, among other agencies that are responsible for a successful discharge of the patient. Information exchange among these agencies during transitional care may aid in the reduction of hospital readmission (Bottle, Aylin, & Bell, 2013). Through effective communication approach standard coordinating care with multiple settings and providers, involving the patient and family caregivers in the plan of care as well as conducting post-discharge follow-up phone calls may be developed hence minimizing the rate of hospital readmission which in turn improves the quality of health care and reduces the health care cost.

Methodology and design of the study

            The health facility readmission has continued to increase the cost of health care in the United States. Health care readmission is often regarded to be an essential tool for measuring the quality of the health care services that particular health care services provider. It is not quite easy to measure quality based on readmission rate of the patient, but it tends to make more sense that a patient tends to be readmitted because the services he was provided with were not of high quality hence not being able to meet his or her health needs. Often readmission is caused by adverse outcomes from a previous treatment. The primary purpose of this study is to determine if the rate of hospital readmission tends to be an accurate measure of quality in the health sector.

            To be able  to attain  effective results  relating to the  research  question the study design that I used  was the grounded theory approach.  The study  design was the most appropriate approach because it tends to emphasize on developing hypothesis based on the research information collected. The strategy would assist me in being able to understand the research question and situation of research to develop a theory that asserts that the frequency of hospital readmission tends to measure the quality of health services provided by the health care facility. The setting of the study design involved several patient care units at a tertiary- care and academic center hospital.  The methodology that was used to attain information was interviewing the patients based on how they felt if they would be readmitted within 30 days of discharge. Also, the care providers were interviewed on what they thought was the primary cause of readmission and how it impacted the relationship they have with their patients. The interview conducted on the patients involved a questionnaire which comprised of about five items. Every item required the patient to provide a yes or no answer. Besides, there was a face to face interview, which allowed the researcher to attain the patient’s perspective on the issue of readmission. Also, the health care providers were provided with a question which had eight items all which were in relation to ways of reducing hospital readmission. Also, the researchers conducted a face to face interview, which enabled them to understand the health providers perspective on health readmission and how they measure the quality of health they provide. Generally, to be able to attain the relevant information, the researchers used the semi-structured interviews on health care providers and patients in different health care settings. A typical sampling case study of about 20 health care providers and 50 patients was conducted.  The interviews focused on the issue of readmission, and also codes were developed and analyzed based on the responses using the grounded theory.

Sampling methodology

            The research was conducted at various patient care units in a leading public health facility in the  United States. The first services of the health facility were Surgical ICUs, Cardiovascular, and general medical services. The health facility often provides health care services to more than 40, 000 patients annually, and it holds an average of 700-bed capacity. The rates that were used in the study were similar to the national standards.

            The participants of the study were recruited using public advertisements, as well as referrals. The recruitment process avoided the exclusion and inclusion criteria because the survey was a typical case sampling. Therefore the individuals who were selected to participate in the study were conventional health care providers who were the representative to the health care process while the patients typically represented the community population and how they felt in regards to hospitalization.

            The Institutional Review Board and the Nursing Research Review Committee approved the study. Also, every individual participating was provided with a copy of consent as a participants reference. Before commencing with the research or interview the researcher verbally reviewed the study with the participant in detail. Individuals interested in participating in the survey provided a verbal affirmation of consent. Written consent was waived to prevent linking of personal identifiers to the interview data during the consent process period.

Research tools

            Researchers may use different techniques to attain information for their research. The methods may be either primary or secondary. The primary tools for achieving knowledge include the questionnaires as well as statistical data. On the other hand, secondary research tools include the internet, research journals, and interviewing people. The tools that  I found to be essential and necessary in the study were the internet, talk from the research participants, and the research journals. All these tools enable me to have a more in-depth understanding of the research question in focus.

Algorithm or flowchart created

            The findings of the research showed that health care readmission was majorly contributed by the inability to create discharge processes which are of quality standard, minimal preparation of patients and families for the discharge, poor communication and minimum education to he patients in regards to the essentialness of the treatment approach.  Several studies tend to link the increasing rate of readmission with inadequate follow up by the primary care providers and other concerned healthcare facilities

References

Al-Amin, M. (2016). Hospital characteristics and 30-day all-cause readmission rates. Journal of Hospital Medicine, 11(10), 682-687. doi:10.1002/jhm.2606

Axon, R. N., & Williams, M. V. (2011). Hospital Readmission as an Accountability Measure. JAMA, 305(5), 504. doi:10.1001/jama.2011.72

Ballard-Hernandez, J. (2010). Nurse practitioners improving the transition from hospital to home and reducing acute care readmission rates in heart failure patients. Heart & Lung, 39(4), 365-366. doi:10.1016/j.hrtlng.2010.05.031

Bottle, A., Aylin, P., & Bell, D. (2013). Predictors of Readmission in Heart Failure Patients Vary by Cause of Readmission: Hospital-Level Cause-Specific Readmission Rates Show No Correlation. 2013 IEEE International Conference on Healthcare Informatics. doi:10.1109/ichi.2013.88

Lackey, T. L. (2015). How transitional care can be the answer to reducing hospital readmission. Heart & Lung, 44(6), 557-558. doi:10.1016/j.hrtlng.2015.10.035

 
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Implementation

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Implementation

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Institutional Affiliation

Implementation

Introduction

            Following the financial penalties that are being posted on health facilities with a high rate of readmission, more health facilities are being encouraged to develop efforts which will reduce the rate of hospital readmission. The health facilities are creating different interventions which tend to involve several components such as patient education, medication reconciliation, evaluation of the patient needs as well as planning for timely follow-up and appointments.  The Affordable Act of 2010 has continued to hold the health facilities responsible for the rate of readmission, which may be prevented. The NCAL/AHCA Quality Initiative tends to include measurable goals of minimizing the 30day hospital readmission b.y about 15%. This means that the health facilities are under tight pressure to protect their revenue and still be able to provide the patients with quality and satisfactory health care services. In the research conducted it proved that most health care readmissions tend to occur due to the inability to create discharge processes which are of quality standard, minimal preparation of patients and families for the discharge, poor communication and minimum education to he patients in regards to the essentialness of the treatment approach.  Several studies tend to link the increasing rate of readmission with inadequate follow up by the primary care providers and other concerned healthcare facilities. The answer to resolving this issue tends to be revolving around predictable steps which may be taken to improve these measures. Every health facility that wants to continue providing health care services to the United States citizens it needs to ensure that it has an approach of minimizing the rate of hospital readmission. This paper will focus on the necessary steps that a health facility may use to ensure that it minimizes the rate of readmission in the future.

Implimenting steps to reduce hospital readmission

  1. Tightening the healthcare processes

            Most the causes of the preventable readmissions in the health facilities tend to revolve around issues which are predictable and may be understood as well as managed, ranging from the intake process to the discharge process. The healthcare facility needs to engage its team players to be able to identify as well as troubleshoot the segments in the health facilitythat contribute to readmission(Simorangkir & McGuire, 2017). Some of the areas that most health facilities need to focus on are the preadmission process- this tends to be a kind of readmission that tends to occur because the health facility is not able to effectively care for the patient. The health facility needs to focus on this segment to be able to understand the level of expertise it needs to add in its team to provide quality care. It is essential for the health facility to train its staff to enable them to be able to take higher volumes of specialized diagnoses. The health facility needs to track the outcome and provide a report to the health facility- this provides evidence that the specialties are doing their work effectively.

            Advance Directives is another approach that the health facility can tighten its health care processes. This step tends to have a significant implication because it assists in reducing questions from the staff, it mitigates the concerns of the family members, as well as it, prevent hospital readmission by maintaining resident within your building(Nuckols, 2015). The health facility needs to work its workforce to ensure and adjust workflows by collecting advance directives information during the period of admission to be able to develop adequate treatment approach for the patient. The health facility needs to make the collection of advance directives a requirement for every admission will assist it to be able to create a medication approach that is much easier to follow to reduce readmission. Also, it is essential to identify the best storage approach to store the advance directives of every patient.

      Evaluating vendor contracts is another way of tightening health care processes. A vendor may contribute to the increase in the rate of readmission if he or she does not deliver the required medical tools or medicine on the required time(Nuckols, 2015). Thus every health facility needs to constantly review the vendor contracts to maintain vendors with a constant supply and do away with those who do not provide the supplies on time.Also, it is essential to challenge vendors to tighten turnaround times for services and make service levels conditions of contracts. And help prevent readmissions by speeding needed services that help stabilize patients conditions.

            Nurse Skill Assessment is another step that the health facility may use to tighten the health care process. Generally, in the current era, patients are not only seeking to be provided with health services rather they are seeking for servicing, which satisfy their needs and are of high quality(Nuckols, 2015). It is essential to constantly evaluate the skills of the nurses in the health facility to be able to offer them training where necessary. Evaluation of the skills and qualification will also motivate the nurse to continue improving their knowledge hence reducing the rate of readmission.  

  • Improving Patient Care

Several readmission in the health facilities may be prevented following a lower cost intervention, which is often designed to improve the experience of the patient. The health facility needs to maintain close monitoring in their patients to identify changes in the patient’s health.

Monitoring of the ADL score is an excellent method of improving patient care because it tends to track even the minor changes that may occur in the patient’s health status. This means that a reduction in the  ADL scores the health care facility and the health providers are provided with the heads up that they need to change on the treatment plan and develop a medication plan that supports the patient’s health(Enos, 2017). Constant monitoring of the ADL scores can assist the health facility in minimizing the rate of unnecessary readmissions.

Creation of alerts is another way that a health facility may improve the care of its patients by developing techniques to monitor the changes in the patient’s condition and follow up treatment(Enos, 2017). When the patient’ condition is more critical, the higher the need for health care to pay close attention to his or her health condition to determine if the condition is improving or deteriorating.

Managing medication is a critical aspect of ensuring that the patients’ care is improved. Several pieces of research have proved that medication adherence reduces the rate of readmission with about 10- 20%. It is essential for the health facility administration to concentrate on identify the trends of refusal of care and also monitor the reasons behind the refusal trends to be able to develop a treatment approach that the patient prefers.

Developing an effective discharge planning is another step that may assist the health facility in improving its patient care as well as reduce the rate of readmission. The health facility needs to develop concise instructions which tend to promote adherence and healing by developing an easy to follow and apply discharge instructions which include medication, side effects of the treatment as well as assistive medical devices.

  • Excellent data management

The effort the health facility makes to reduce the rate of readmission is directly linked to how excellent and effective they collect the patients’ data. Data collection and management is an essential segment in ensuring that any health facility can provide quality care outcome. This step mainly focuses on how data is captured, used, as well as the leverage care data within the health care operation(Askren-Gonzalez & Frater, 2012).

Improving the workflow of data capture is the first step to having excellent data management. When the health facility can collect more data from the patient, it can have a better image of the patient’s health.  When data is captured more, it provides room for triggering negative alerts regarding the patient’s health. It is essential to scrutinize every workflow to tighten up the time between interaction and documentationThis enables the health care facility to be able to address issues which trigger a high rate of readmission.

            Patient condition Summary is another step that assists the health facility in improving its data management(Askren-Gonzalez & Frater, 2012). This step aids in preventing unnecessary hospital readmission by focusing on the causative aspects and developing a consolidated image of the patient’s health. For instance, the patient may react differently with the treatment provided, and due to the frequent condition summary, the health care can identify the issue and change the medication plan.

            Implementing a Quality Assessment, Performance Initiative (QAPI) allows the health care facility to develop new policies which enforce quality and management tracking. This initiative may aid in the reduction of hospital readmission by Pointing out and fixing the risk areas. QAPI enables health care to maintain quality care through the use of patient data.

References

Askren-Gonzalez, A., & Frater, J. (2012). Case Management Programs for Hospital Readmission Prevention. Professional Case Management, 17(5), 219-226. doi:10.1097/ncm.0b013e318257347d

Enos, G. (2017). Provider team steps in to reduce payer’s hospital readmission rate. Mental Health Weekly, 27(15), 1-7. doi:10.1002/mhw.30999

Nuckols, T. K. (2015). County-Level Variation in Readmission Rates: Implications for the Hospital Readmission Reduction Program’s Potential to Succeed. Health Services Research, 50(1), 12-19. doi:10.1111/1475-6773.12268

Simorangkir, H., & McGuire, S. J. (2017). Training in Readmission Reduction in an Indonesian Hospital. Hospital Topics, 95(2), 40-50. doi:10.1080/00185868.2017.1300477

 
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nursing

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Discussion will be a minimum of 250 words. Make sure you provide appropriate references and utilize APA style.. Each discussion will be allocated to a specific Master’s Essential. Discussion Rubric is attached Research project is attached.

1- Propose a research question related to your potential research project that would require a qualitative research approach. Select the best qualitative method that could answer the research question proposed? What are the strengths and weaknesses of that method?

2-Identify a practice issue that would benefit from utilizing a mixed methods approach. Discuss how the quantitative and qualitative data would complement one another and add strength to the study. Discuss the challenges that you might encounter in using a mixed methods approach. Support your discussion using current mixed methods research articles.

 
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