PATH ALONG Lot Of Variables Drive Hospital Readmissions

The difficulty long term planners identify in establishing strategies to reduce hospital readmissions is the wide extending capacity of contributing factors.  There is no individual, clear cut driver to the  excessive hospital readmission rates. 

Clearly the differences in the hospital case mix can result in a variation in readmission rates when comparing similar organizations of provision.  Major teaching hospitals tend to have slightly higher readmission rates.  Increased age and severity of illness collaborate with higher readmission rates. 

The health organizations model for staffing may contribute to an identified risk for hospital readmission.  Community hospitals have employed the hospitalist (Medical Doctor) to follow the inpatient population.  Studies suggest a communicative gap between the hospitalist and the patients primary medical doctor.

The hospitalist's tasks are oriented toward  documentation and not comprehensive verbal notification.
Data suggests this would leave the patients themselves as the main source of the detailed information on the hospital stay.  With the increased severity of illness payers require for hospitalization this reduces the patients ability to process and store communicated instruction.  In a typical discharge scenario everyone seems able to follow instructions and self monitor in the home setting. 

Studies suggest effectiveness is tied to consistency from the hospital bed and in to the home bed room.  Models with the consistent presence of another seem to demonstrate favorable statistical change.  This is important, because the diversion of readmission revenue is not strong enough to cause a hospital accounting committee to invest in a readmission reduction model when the savings do not exceed the direct cost of the intervention.

PATH ALONG is an original Wisconsin model that connects inpatient providers to community staff who support the patient during health system transitions.  PATH ALONG is an evidence based model with three defined services to help the hospitalist fulfill their continuity of care role.  The focus is on care filled transitions.

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