Tracking the Sustainability of Improvements in Hospital Outcomes
ABSTRACT
This study focused on tracking the sustainability of improvements in inpatient outcomes in the hospitals of Syracuse, New York. It involved evaluation of inpatient complications during a six-year period for two of the Syracuse hospitals and inpatient readmissions during a three-year period for three hospitals. The study employed the Potentially Preventable Complications and Potentially Preventable Readmissions software developed by 3MTM Health Information Systems. The study demonstrated that two of the Syracuse hospitals produced reductions in aggregate complication rates between 2009 and 2012. This was followed by an increase in complications during 2013 and 2014. The decline in complications and the increase that followed were supported by developments in high volume complications and some lower volume complications. Hospital readmissions for adult medicine, the largest inpatient service, both increased and declined at the aggregate level and for individual hospitals during the three-year period. Hospital readmission rates for adult surgery declined, however, individual hospital rates increased and declined. The study identified sustained reductions in readmission rates for the combined hospitals for congestive heart failure and COPD during the three-year period. The study identified the challenges related to sustaining reductions in hospital outcomes over time. In the Syracuse hospitals, these challenges involved inpatient clinical management for complications and system-wide issues for readmissions.
This study focused on tracking the sustainability of improvements in inpatient outcomes in the hospitals of Syracuse, New York. It involved evaluation of inpatient complications during a six-year period for two of the Syracuse hospitals and inpatient readmissions during a three-year period for three hospitals. The study employed the Potentially Preventable Complications and Potentially Preventable Readmissions software developed by 3MTM Health Information Systems. The study demonstrated that two of the Syracuse hospitals produced reductions in aggregate complication rates between 2009 and 2012. This was followed by an increase in complications during 2013 and 2014. The decline in complications and the increase that followed were supported by developments in high volume complications and some lower volume complications. Hospital readmissions for adult medicine, the largest inpatient service, both increased and declined at the aggregate level and for individual hospitals during the three-year period. Hospital readmission rates for adult surgery declined, however, individual hospital rates increased and declined. The study identified sustained reductions in readmission rates for the combined hospitals for congestive heart failure and COPD during the three-year period. The study identified the challenges related to sustaining reductions in hospital outcomes over time. In the Syracuse hospitals, these challenges involved inpatient clinical management for complications and system-wide issues for readmissions.
Cite this paper
Lagoe, R. and Lagoe, R. (2014) Tracking the Sustainability of Improvements in Hospital Outcomes. Advances in Bioscience and Biotechnology, 5, 895-902. doi: 10.4236/abb.2014.511104.
Lagoe, R. and Lagoe, R. (2014) Tracking the Sustainability of Improvements in Hospital Outcomes. Advances in Bioscience and Biotechnology, 5, 895-902. doi: 10.4236/abb.2014.511104.
References
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http://dx.doi.org/10.1377/hlthaff.2011.0961 [2] Iglehart, J.K. (2011) Desperately Seeking Savings: States Shift More Medicaid to Managed Care. Health Affairs, 30, 1627-1629.
http://dx.doi.org/10.1377/hlthaff.2011.0836 [3] Auerbach, D.L. and Kellerman, A.L. (2011) A Decade of Health Care Cost Growth Has Wiped out Real Income Gains for an Average US Family. Health Affairs, 30, 1630-1636.
http://dx.doi.org/10.1377/hlthaff.2011.0585 [4] Skinner, J., Chandra, A., Goodman, D. and Fisher, E.S. (2009) The Elusive Connection between Health Care Spending and Quality. Health Affairs, 28, 1256-1258. [5] Hoonhout, L.H., de Bruinje, M.C., Wagner, C., Zeegers, W., Waajman, R., Spreeuwenberg, P., Asscherman, H. and van der Wal, G. (2009) Direct Medical Costs of Adverse Events in Dutch Hospitals. BMC Health Services Research, 9, 27.
http://dx.doi.org/10.1186/1472-6963-9-27 [6] Rau, J. (2012) Medicare to Penalize 2211 Hospitals for Excess Readmissions. Kaiser Health News, Menlo Park, California. [7] Sheng, W.H., Wang, J.T., Lu, D.C., Chie, W.C., Chen, Y.S. and Chang, S.C. (2005) Comparative Impact of Hospital-Acquired Infections on Medical Costs, Length of Hospital Stay, and Outcome between Community Hospitals and Medical Centres. Journal of Hospital Infections, 59, 205-214.
http://dx.doi.org/10.1016/j.jhin.2004.06.003 [8] Venditti, M., Falcone, M., Corrao, S., Licata, G. and Serra, P. (2009) Outcomes of Patients Hospitalized for Community-Acquired, Health Care-Associated, and Hospital Acquired Pneumonia. Annals of Internal Medicine, 150, 19-26.
http://dx.doi.org/10.7326/0003-4819-150-1-200901060-00005 [9] Jencks, S.F., Williams, M.V. and Coleman, E.A. (2011) Rehospitalizations among Patients in the Medicare Fee for Service Program. New England Journal of Medicine, 364, 1582.
http://dx.doi.org/10.1056/NEJMx110014 [10] Hughes, J.S., Averill, R.F. and Goldfield, N.J. (2006) Identifying Potentially Preventable Complications Using a Present on Admission Indicator. Health Care Financing Review, 27, 63-82. [11] Fuller, R.L., McCullough, E.C., Bao, M.Z. and Averill, R.F. (2009) Estimating the Costs of Potentially Preventable Hospital Acquired Complications. Health Care Financing Review, 30, 17-32. [12] Goldfield, N.I., McCullough, E.C., Hughes, J.S., Tang, A.M., Eastman, B., Rawlins, L.K. and Averill, R.F. (2008) Identifying Potentially Preventable Readmissions. Health Care Financing Review, 30, 75-92. [13] Lagoe, R., Pasinski, T., Kronenberg, P., Quinn, T. and Schaengold, P. (2006) Linking Health Services at the Community Level. Canada Healthcare Quarterly, 9, 60-65.
http://dx.doi.org/10.12927/hcq..18229 [14] Lagoe, R.J. and Westert, G.P. (2010) Evaluation of Hospital Inpatient Complications: A Planning Approach. BMC Health Services Research, 10, 200.
http://dx.doi.org/10.1186/1472-6963-10-200 [15] Lagoe, R.J., Nanno, D.S. and Luziani, M.E. (2012) Quantitative Tools for Addressing Hospital Readmissions. BMC Research Notes, 5, 620.
http://dx.doi.org/10.1186/1756-0500-5-620 [16] Iezzoni, L.J., Daely, J., Heeren, T., Foley, S.M., Fisher, E.S., Duncan, C., Hughes, J.S. and Coffman, G.A. (1994) Identifying Complications of Care Using Administrative Data. Medical Care, 32, 700-715.
http://dx.doi.org/10.1097/00005650-199407000-00004 [17] Agency for Health Care Research and Quality (2003) National Healthcare Quality Report. U.S. Department of Health and Human Services, Rockville, MD. [18] (2008) 3M Health Information Systems: Potentially Preventable Readmissions Classification System. 3M Health Information Systems, Wallingford, Conn.
[1] Dentzler, S. (2011) Urgent Measures for an Old Problem. Health Affairs, 30, 1626.
http://dx.doi.org/10.1377/hlthaff.2011.0961 [2] Iglehart, J.K. (2011) Desperately Seeking Savings: States Shift More Medicaid to Managed Care. Health Affairs, 30, 1627-1629.
http://dx.doi.org/10.1377/hlthaff.2011.0836 [3] Auerbach, D.L. and Kellerman, A.L. (2011) A Decade of Health Care Cost Growth Has Wiped out Real Income Gains for an Average US Family. Health Affairs, 30, 1630-1636.
http://dx.doi.org/10.1377/hlthaff.2011.0585 [4] Skinner, J., Chandra, A., Goodman, D. and Fisher, E.S. (2009) The Elusive Connection between Health Care Spending and Quality. Health Affairs, 28, 1256-1258. [5] Hoonhout, L.H., de Bruinje, M.C., Wagner, C., Zeegers, W., Waajman, R., Spreeuwenberg, P., Asscherman, H. and van der Wal, G. (2009) Direct Medical Costs of Adverse Events in Dutch Hospitals. BMC Health Services Research, 9, 27.
http://dx.doi.org/10.1186/1472-6963-9-27 [6] Rau, J. (2012) Medicare to Penalize 2211 Hospitals for Excess Readmissions. Kaiser Health News, Menlo Park, California. [7] Sheng, W.H., Wang, J.T., Lu, D.C., Chie, W.C., Chen, Y.S. and Chang, S.C. (2005) Comparative Impact of Hospital-Acquired Infections on Medical Costs, Length of Hospital Stay, and Outcome between Community Hospitals and Medical Centres. Journal of Hospital Infections, 59, 205-214.
http://dx.doi.org/10.1016/j.jhin.2004.06.003 [8] Venditti, M., Falcone, M., Corrao, S., Licata, G. and Serra, P. (2009) Outcomes of Patients Hospitalized for Community-Acquired, Health Care-Associated, and Hospital Acquired Pneumonia. Annals of Internal Medicine, 150, 19-26.
http://dx.doi.org/10.7326/0003-4819-150-1-200901060-00005 [9] Jencks, S.F., Williams, M.V. and Coleman, E.A. (2011) Rehospitalizations among Patients in the Medicare Fee for Service Program. New England Journal of Medicine, 364, 1582.
http://dx.doi.org/10.1056/NEJMx110014 [10] Hughes, J.S., Averill, R.F. and Goldfield, N.J. (2006) Identifying Potentially Preventable Complications Using a Present on Admission Indicator. Health Care Financing Review, 27, 63-82. [11] Fuller, R.L., McCullough, E.C., Bao, M.Z. and Averill, R.F. (2009) Estimating the Costs of Potentially Preventable Hospital Acquired Complications. Health Care Financing Review, 30, 17-32. [12] Goldfield, N.I., McCullough, E.C., Hughes, J.S., Tang, A.M., Eastman, B., Rawlins, L.K. and Averill, R.F. (2008) Identifying Potentially Preventable Readmissions. Health Care Financing Review, 30, 75-92. [13] Lagoe, R., Pasinski, T., Kronenberg, P., Quinn, T. and Schaengold, P. (2006) Linking Health Services at the Community Level. Canada Healthcare Quarterly, 9, 60-65.
http://dx.doi.org/10.12927/hcq..18229 [14] Lagoe, R.J. and Westert, G.P. (2010) Evaluation of Hospital Inpatient Complications: A Planning Approach. BMC Health Services Research, 10, 200.
http://dx.doi.org/10.1186/1472-6963-10-200 [15] Lagoe, R.J., Nanno, D.S. and Luziani, M.E. (2012) Quantitative Tools for Addressing Hospital Readmissions. BMC Research Notes, 5, 620.
http://dx.doi.org/10.1186/1756-0500-5-620 [16] Iezzoni, L.J., Daely, J., Heeren, T., Foley, S.M., Fisher, E.S., Duncan, C., Hughes, J.S. and Coffman, G.A. (1994) Identifying Complications of Care Using Administrative Data. Medical Care, 32, 700-715.
http://dx.doi.org/10.1097/00005650-199407000-00004 [17] Agency for Health Care Research and Quality (2003) National Healthcare Quality Report. U.S. Department of Health and Human Services, Rockville, MD. [18] (2008) 3M Health Information Systems: Potentially Preventable Readmissions Classification System. 3M Health Information Systems, Wallingford, Conn.