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What Has the Biggest Impact on Hospital Readmission Rates?

Study suggests that improved doctor–patient relationship reduces readmissions

Although many hospitals invest in hotel-like amenities to improve the patient experience, hospital leaders would be better off spending more money on improving caregiver–patient communication — the number-one factor in preventable readmissions, according to research published in Management Science.

In fact, the results indicate that a hospital would, on average, reduce its readmission rate by 5 percentage points if it were to prioritize communication with the patients in addition to complying with evidence-based standards of care.

Researchers, led by Claire Senot of Tulane University and Aravind Chandrasekaran of Ohio State University, examined whether improving two different dimensions of patient experience, measured using the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) scores and process-of-care measures, impacted hospital readmissions.

The communication-focused dimension corresponds to the caregiver’s ability to engage in meaningful conversations with the patient. The response-focused dimension corresponds to the caregiver’s ability to respond quickly to a patient’s explicit needs. Improving these dimensions requires different hospital resources. While the response-focused dimension benefits from investments in things like visual monitoring systems and RFID location systems, the communication-focused dimension benefits from training programs that teach interpersonal skills and empathy to caregivers.

The research examined the relationship between these patient-experience dimensions, the process of care, and a hospital’s performance in terms of readmissions and operating costs. Researchers supplemented their analyses with in-depth case studies of five acute-care hospitals that involved nearly 50 semistructured interviews with hospital administrators, physicians, and nurses.

Results from these efforts collectively suggest that when the process-of-care quality is high, improving on the communication-focused dimension has a much stronger effect on reducing readmission rates when compared with improving on the response-focused patient-experience dimension. In fact, the communication-focused dimension and process-of-care combo results in a 5-percentage-point reduction in 30-day readmission rates for an average U.S. hospital. The reduction is just under 3 percentage points for the response focus and process-of-care combo. The net difference of over 2 percentage points for an average hospital is a conservative estimate and compares results for only a 1% increase in the patient-experience dimension.

If these results are so powerful, why aren’t hospitals focusing on improving this patient-experience dimension? The answer is that improving the communication-focused dimension involves significant training costs, in part because health care traditionally has focused on the evidence-based process of care rather than the patient experience. This bias is reflected in medical education, which teaches technical skills to caregivers and puts relatively little emphasis on the importance of interacting with the patient.

Thus, while investing in cultural change represents a daunting task for hospitals, investing in amenities might appear to be an attractive alternative. Interestingly, the research shows that, when process-of-care quality is high, improving the communication-focused dimension of the patient experience is less expensive ($48 per patient discharged from an average U.S. hospital for a 1-percentage-point increase in patient-experience scores) than improving the response-focus dimension ($62 per patient discharged from an average U.S. hospital for a 1-percentage-point increase in patient-experience scores).

These results present an interesting cost-quality tradeoff for U.S. hospitals. While it is generally costly for hospitals to improve the patient experience, these costs are lower and the benefits are higher if, in combination with a high-quality process of care, the focus is directed at improving communication between caregivers and patients. This has a dual effect of not only being less expensive but also far superior in reducing readmissions. These results have important implications for where hospital administrators should invest to improve the overall health care delivery system in the United States.

Sources: Harvard Business Review; September 23, 2015; Fierce HealthCare; September 24, 2015.

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