A Readmission Breakthrough: How a New Discharge Solution Reduced Readmissions by 27.5%
Reducing hospital readmissions remains a priority for organizations operating in value-based care. Yet many post-discharge solutions can be difficult to scale because of the cost and operational burden required to effectively support care teams.
ilumed, an accountable care organization (ACO), partnered with Connective Health, a healthcare technology company, to take a different approach: give clinicians the clinical context they need at the moment they engage with recently discharged patients.
The result was a 27.5% reduction in hospital readmissions among patients whose clinicians received and used an electronic discharge summary during follow-up.
The Challenge: Closing the Gap After Discharge
When a patient is readmitted to the hospital, the experience can be traumatic for the patient and costly for the healthcare system.
To help prevent avoidable readmissions, value-based care organizations invest in post-discharge follow-up programs. But those programs depend on clinicians having timely, accurate information about a patient's recent hospitalization.
Obtaining that information can be challenging.
Traditionally, clinicians may need to navigate a combination of faxes, phone calls and EHR portal logins to retrieve hospital records and understand what happened during a patient's stay.
That creates an operational burden at exactly the time when care teams need to be focused on engaging the patient and addressing their needs.
The Solution: Bringing Discharge Information Into the Clinical Workflow
Connective Health's technology retrieves electronic health records from hospitals, distills the information into simple discharge summaries and delivers those summaries directly into ilumed's clinical workflow.
The approach was designed to give clinicians the information they need without requiring them to spend valuable time tracking down records.
The solution included three key capabilities:
- Standardized discharge summaries with complete clinical context
- Delivery into the point of care, so clinicians can access information within their workflow
- Proactive risk identification to support timely interventions
The Impact: 27.5% Lower Readmission Rate
The difference was significant.
Patients whose clinicians received and used the discharge summary had an 11% hospital readmission rate, compared with 16% among patients whose clinicians did not use the discharge summary.
That represents a 27.5% percentage reduction in the readmission rate.
Readmission Rate
Without the new solution: 16%
With the new solution: 11%
Percentage reduction: 27.5%
Rethinking Post-Discharge Workflows
The results demonstrate the potential impact of making clinical information more accessible within existing care workflows.
Rather than requiring care teams to spend time retrieving and piecing together hospital records, the approach gives clinicians access to a standardized discharge summary with the clinical context they need to engage patients more effectively.
As Marri Brackman, DO, Chief Medical Officer at ilumed, put it:
“By rethinking post-discharge workflows, ilumed and Connective Health enabled care teams to focus on patient engagement rather than data retrieval.”
The Takeaway
For value-based care organizations, reducing readmissions isn't simply about adding another follow-up program. It's also about giving clinicians the information they need to make those interventions effective.
The ilumed and Connective Health approach demonstrates how improving access to post-discharge clinical information can help care teams shift their focus from retrieving data to engaging patients.
In this case, that shift was associated with a 27.5% reduction in hospital readmissions.