Discharge Resources for Chronic Cardiorespiratory Issues

Question
Discharge Resources for Chronic Cardiorespiratory Issues

Answer
1. Introduction
Perhaps the most compelling reason why patients with chronic medical conditions are frequently readmitted to the hospital is the lack of professional care available to them once they are discharged.
One study found that there was a mismatch between what patients and physicians said about what level of functionality the patient should be at before discharge. Phase I of the study showed that the physician thought 63% of patients could be independent in taking care of their illness, while only 37% of the patients said they could. This disparity in perception of the patient’s ability to take care of his/her illness mostly results in premature discharge of the patient.
One reason for readmission is that chronic medical illnesses are often not resolved at hospital discharge. This is evident because one-third of patients have a recurrence of the same illness within 2 weeks of hospital discharge. The reasons for patients leaving the hospital before their illness is adequately resolved are manifold. Usually, the patient and the doctor feel that they can take care of the remaining illness at home.
Chronic medical illnesses account for a greater percentage of patient conditions and diseases that contribute to hospital readmission. Although the acute treatment received by the patient in the hospital is often excellent, chronic medical conditions are often not resolved and the patients are frequently left without proper care. They often must fend for themselves in managing their chronic medical conditions, and their illnesses often become exacerbated, leading to a resumption of acute treatment.
1.1. Definition of chronic cardiorespiratory issues
According to the Respiratory Resource Centre in Ottawa, chronic illness is defined as the presence of an illness that is prolonged, does not often resolve, and is rarely cured completely. Cardio-respiratory diseases are chronic illnesses and are considered to be the leading health problem in Canada. They affect the heart and lungs and can greatly impact the patient’s quality of life. Some examples of cardio-respiratory diseases are hypertension, heart disease, stroke, asthma, and diabetes. The management of these diseases is vital to the patient’s overall health and well-being. Although chronic cardio-respiratory diseases are often managed in the community setting, there are also a significant number of patients who require care in the acute care setting. The burden of health care utilization in Canada continues to grow, as there are increasing numbers of patients being admitted to the hospital with acute exacerbations of their chronic diseases. This is particularly true for respiratory diseases. With the burden of health care utilization comes an increasing demand for efficient resource utilization as well as an increased focus on health system outcomes. The fluctuating nature of chronic diseases means that coping with these illnesses can be difficult for patients. A common problem for patients dealing with an exacerbation of their cardio-respiratory disease is the inability to return to their baseline level of function. This is often due to muscle deconditioning and/or a decrease in dyspnea tolerance. These patients often require additional support and resources to help them regain their independence and previous level of functioning. Failure to do so can greatly impact a patient’s quality of life. With an aging population and an increasing emphasis on keeping patients out of hospitals, it is important to help patients learn self-management skills and be as independent as possible. The ultimate goal is to prevent further exacerbations of their diseases and to help them maintain their highest level of function.
1.2. Importance of discharge resources for patient independence
Success in reducing acute healthcare usage occurs when the patient is able to comfortably and confidently manage their health condition using the recommended treatment and symptom management techniques, without the need for unscheduled visits to a healthcare facility. This is commonly referred to as self-management. High-quality self-management has positive outcomes for the patient and reduces cost to the healthcare system. In order for self-management to occur, a patient must understand their condition and the actions which must be taken to manage it, the patient must have confidence in their ability to take these actions, and the patient must have the necessary resources to carry the actions out.
The importance of discharge resources for patient independence cannot be underestimated. In the context of chronic cardiorespiratory issues, it has been shown that far more attention needs to be focused on the patient’s discharge planning in an effort to impede the reoccurrence of symptoms and decrease the likelihood of hospital readmission. A strong, consistent factor in the literature is the profound effect that the implementation of effective discharge planning can have on the patient’s quality of life without increasing the economic burden on the already strained healthcare system. The goal of discharge planning is to reduce the time the patient spends being acutely ill (that is, time spent in hospital or with a doctor visit) and to help the patient manage his or her own health effectively. The means in which this is achieved is varied but the implications of its success are profound and far-reaching.
1.3. Impact of readmission on reimbursement and hospitals
An important factor that drives the push for quality improvement is the Medicare perspective payment system, where hospitals that treat a higher proportion of low-income patients with multiple chronic conditions will be expected to lose a significant amount of their Medicare payment. It is estimated that payment reductions can be up to 3% of the reimbursement value in 2015 and 2017 (Haveman, 2013). This can create financial strain on already resource-poor safety-net hospitals. Readmission can result in financial penalization of the hospital. In 2012, 2,200 hospitals received penalties ranging from 1% to discharge 1.5 billion in total (Martin & Lassman, 2013), and in 2013, this increased to 2,600 hospitals (Health policy, 2013). This extra money can be crucial for a hospital already struggling with poor reimbursement to put into patient services, and in the current day and age, in a very money-driven healthcare environment, financial penalties due to increased readmission rates may act as an incentive for hospitals to improve the care they provide to reduce readmission rates. On the contrary to reduced reimbursement, for a patient who is readmitted, Medicare will pay for readmission services with an additional DRG payment for the readmission if it takes place within the same DRG window. This may sound like a benefit for the hospital; however, any additional payment will not offset the amount that was lost due to the initial admission.
1.4. Implications of readmission on patients
Soon after discharge from a hospital, the average chronically ill patient has a 20% chance of being readmitted to the hospital within 30 days and a 57% chance within 1 year. These rates have changed little in the past 30 years and readmission remains a common and expensive occurrence. Factors associated with readmission to the hospital include those related to the nature of the illness, the quality of patient care, characteristics of the patient, and the structure of the health care system. Although many readmissions are for medical issues similar to the previous admission, some patients are readmitted for conditions that are complications of medical treatments and some are readmitted for unrelated new medical issues. Given the nature of chronic illnesses and the link between patient functional status and hospital readmission, it is important to consider the effect of readmission on patients’ ability to live in the community and gain independence. High rates of hospital readmission can prevent a patient from leaving the cycle of frequent hospitalization and institutionalization, leading to worsening functional status and increased morbidity. Although this phenomenon has been recognized anecdotally, it is difficult to measure the impact of hospital readmission on patient independence and the ability to live in the community. Improved understanding of the factors that lead to hospital readmission, changes in the care of patients at risk of readmission, and development of interventions to prevent readmission are essential steps to reducing the high rates of hospital readmission and improving the health of chronically ill patients.
2. Discharge Resources for Patient Independence
2.1. Home healthcare services
2.2. Medical equipment and supplies
2.3. Rehabilitation and therapy programs
2.4. Education and self-management resources
3. Preventing Readmission
3.1. Care coordination and transitional care programs
3.2. Medication management and adherence support
3.3. Telehealth and remote monitoring solutions
3.4. Follow-up appointments and outpatient services
4. Impact of Readmission on Reimbursement
4.1. Medicare’s Hospital Readmissions Reduction Program
4.2. Financial penalties for excessive readmissions
4.3. Importance of quality improvement initiatives
4.4. Strategies for reducing readmission rates
5. Implications of Readmission on Hospitals
5.1. Increased healthcare costs
5.2. Overburdened healthcare resources
5.3. Negative impact on hospital reputation
5.4. Importance of patient satisfaction and outcomes
6. Implications of Readmission on Patients
6.1. Physical and emotional toll on patients
6.2. Financial burden of additional healthcare expenses
6.3. Disruption of daily life and routines
6.4. Importance of patient education and empowerment
7. Conclusion
7.1. Recap of discharge resources and their impact
7.2. Importance of preventing readmission for patient well-being and healthcare system sustainability