CLAHRC WM is working with Sandwell and Birmingham Hospitals group to improve care of patients on discharge from hospital. This is a worthwhile exercise since handover from hospital to community is a ‘fault-line’ for safe care. Some think that improving care over this transition may reduce re-admission rates, and indeed differences in re-admission rates across hospital sites within the group prompted the above initiative in the first place.
However, the CLAHRC WM Director is circumspect regarding the prospects for reduced re-admissions. His argument is simple: most re-admissions result from inter-current or progressive disease, while the proportion of re-admissions that are preventable is small, especially beyond the first four weeks after discharge. It follows that re-admissions are a small signal easily buried in noise. This does not, of course, mean that improving care at discharge is not a worthwhile objective.
A recent RCT of an expensive intervention based on one-to-one self-management education from a discharge nurse, backed up by telephone calls after discharge, did not lead to reduced re-admissions and may have actually increased hospital contact overall. Is this yet a further example of an intervention motivated by the need to reduce healthcare utilisation that results instead in improved care but no reduction, or even an increase, in healthcare costs?
— Richard Lilford, CLAHRC WM Director
- Girling AJ, Hofer TP, Wu J, Chilton PJ, Nicholl JP, Mohammed MA, Lilford RJ. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study. BMJ Quality & Safety. 2012; 21: 1052-6.
- Goldman LE, Sarkar U, Kessell E, et al. Support From Hospital to Home for Elders: A Randomized Trial. Ann Intern Med. 2014; 161(7): 472-81.