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Reduce Readmissions With Service-Based Care Management

Amin, Alpesh N. MD, MBA, MACP, SFHM; Hofmann, Heather MD; Owen, Mary M. RN, MPA; Tran, Hai MPA; Tucker, Saran PhD, MPH; Kaplan, Sherrie H. PhD, MPH

doi: 10.1097/NCM.0000000000000051
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Purpose of Study: In response to the U.S. Affordable Care Act, the Centers for Medicare & Medicaid Services proposed a change in reimbursement penalties for hospitals beginning October 1, 2012. Reducing the occurrence of unplanned readmissions has become a more urgently focused topic. As part of the health care system, care management aligns with physicians to significantly improve service, financial, and clinical care outcomes. To address the changing health care climate in 2008, care management services were restructured at an academic university medical center located in 1 of the 3 largest counties in California. Changing from a unit-based to a service-based care management model partnered care managers and social workers with physician services. We sought to assess the effect of this change on surrogates for patient experience and clinical quality of care.

Primary Practice Setting: Tertiary academic medical center in southern California.

Methodology and Sample: Retrospective data were collected from 2 databases for all hospital patient care services from November 2008 to January 2010 to determine whether clinical quality of care and experiential service improvements were realized. Primary outcomes included all-cause and related readmission rates. Secondary outcomes were Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) scores. An interrupted time series analysis compared data from the single institution for the diffusion and postintervention periods.

Results: Comparing data from the diffusion and postintervention periods, the rate of disease-related readmissions decreased significantly (mean 5.43–4.58, p < .05), and all-cause readmissions also decreased, although the difference failed to achieve statistical significance (11.42-10.49, p = .056). H-CAHPS scores with the patient response of “recommend this hospital” was unchanged over the 2 time points (mean 78.9%–77.8%, p = .26731). Data also showed stable care management staffing rates whereas average daily census (ADC) increased over time (ADC 274–297).

Implications for Case Management Practice: With health reform driving value-driven care transformation, partnering care managers and social workers with physician services has the potential to impact the patient's experience as well as financial and clinical care outcomes. Care managers serve a significant role in improving the clinical quality of care by reinforcing a consistent and clear message by the health care team to the patient during the entire hospitalization, not just at the time of discharge. At one institution, partnering physicians with care managers through the acute care continuum (service-based care management) appeared to reduce readmissions without compromising patient satisfaction. Both readmission reduction and effective patient satisfaction scores impact the Centers for Medicare & Medicaid Services value-based purchasing reimbursement calculations.

Alpesh N. Amin, MD, MBA, MACP, SFHM, is Tom and Mary Cesario Chairman, Department of Medicine, the University of California–Irvine (UC Irvine). He is Professor of Medicine, Business, Public Health and Nursing at UC Irvine. He is also founder and executive director of the Hospitalist Program.

Heather Hofmann, MD, is a resident physician in the Department of Medicine at UC Irvine with a research interest in quality improvement in the inpatient setting.

Mary M. Owen, RN, MPA, is currently the director of Patient Experience at the University of California, Irvine Health. Previously, she spent 15 years as the senior director of Quality and Care Management at UC Irvine Health, where the service-based care management model was implemented.

Hai Tran, MPA, is currently a senior analyst in Quality & Patient Safety Department at UC Irvine Health.

Saran Tucker, PhD, MPH, is currently a part-time Professor of Health Sciences at California State University, Fullerton. She is also founder of The Data Result, LLC, a data management consulting firm. Previously, she was the manager of Quality & Patient Safety Department at UC Irvine Health.

Sherrie H. Kaplan, PhD, MPH, is the assistant vice chancellor of Healthcare Measurement and Evaluation in the UC Irvine School of Medicine and executive co-director of the Health Policy Research Institute at the University of California, Irvine.

Address correspondence to Alpesh N. Amin, MD, MBA, MACP, SFHM, University of California, Irvine Health, 333 City Boulevard West, Suite 400, Orange, CA 92868 (anamin@uci.edu).

The authors report no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.