Tag Archives: hospital re-admissions

Accountable Care and Effective Physician-Patient Communications – You Can’t Have One Without the Other

[tweetmeme source=”Healthmessaging” only_single=false]Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act.   The concept behind Accountable Care Organizations is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia), we can expect to see an improvement in quality and value.

In principal accountable care makes a lot of sense.   Practically speaking however, doctors and hospitals must address a huge challenge before they can expect benefit financially.

Before doctors can be held accountable for the care they deliver, they first must be held accountable for the quality of their communication with patients.

Take hospital re-admissions which are a big cost-driver today.   According to a recent study in the New England Journal of Medicine, 20% of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34% percent within 90 days.

The Joint Commission and others believe rightly believe that inadequate communication between physicians, as well as between physicians and patients, is a major contributing factor.

Here’s an example.   In a small study of 47 patients surveyed at time of hospital discharge (Commercial and Medicare), 72.1% of patients were unable to list all their discharge medications.  86% were unable to describe the common side effect(s) of all their medications, and 58.1% did not know the diagnoses that put them in the hospital in the first place.  These trends are consistent with the findings from a number of similar studies, including studies of discharged ER patients.

Physician-patient communications shortcomings abound in the doctor’s office as well.    Approximately 20–50% of patients do not take medications as prescribed.  It’s not necessarily because patients are non-compliant.  Patients don’t take medications out of fear of drug interactions, perceived lack of effectiveness, adverse effects, misunderstanding regarding necessity, or concerns about costs.

Patients who report better general communication with their doctor, i.e.,  better instructions on how to take a medication, and who receive more medication information, are more likely to take medications as prescribed.

The success of new financing and delivery models like Accountable Care Organizations and Medical Homes depends heavily upon significant address the quality of the current state of physician-patient communications. I wonder when today’s physician and hospital leaders will get a clue.

Sources:

Makaryus, A., et al. Patients’ Understanding of Their Treatment Plans and Diagnosis at Discharge.  Mayo Clinic Preceedings, 2005.

Coleman, E., Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Medicine. 2009.

Kripalani, S., et al. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians.  JAMA 2008.

Why Can’t Physicians Be More Like Dentists When It Comes To Patient Follow-up?

[tweetmeme http://www.healthecommunications.wordpress.com%5DI have to give my dentist credit.  He and his staff know when I am due for a cleaning and call me to schedule an appointment without fail.  They also call to remind me the day before an appointment.  Many dentists, I understand, do similar kinds of things for their patients.

As a patient, I like being reminded…it is a great service. I also like the fact that someone’s looking out for me.  From a business perspective it makes a lot of sense as well.  Fewer “no shows,” more cleanings, more billings, and so on.

It’s too bad that more physicians don’t routinely follow-up with their patients, particularly when it really counts.

Take the example of 172 patients in a 2008 study by Maniaci et al. of patients discharged from the hospital with a new medication.  Within 3 days of discharge, patients were surveyed about what they “knew” about their new medication based upon what their attending physician told them.

According to the study:

  • 36% of patients did not know the name of the medication they were given
  • 36% of patients did not know what the new medication was supposed to do
  • 44% did not know the proper dosage instructions for the new medication

If this is representative of the quality of physician discharge instructions at most hospitals, is it any wonder that 20% of Medicare hospital discharges end up being re-admitted to the hospital within 30 days….and 34% after 90 days post discharge?

Remember that medical errors are a frequent cause of action in malpractice cases.  Poor physician-patient communications at time of discharge about new medications, follow-up tests, follow-up with their primary care physician, etc. are examples of common medical errors.

In a similar study, Kripalani et al., found that almost 50% of patients sent home with a new medication experienced some degree of medication non-adherence in the 2 weeks following hospital discharge.  When patients in the study were asked what could be done to improve medication use almost 70% said a follow-up phone call to review medication would be helpful.

Why can’t physicians be more like dentists when it comes to proactively following up with patients?

Sources:

Maniaci et al. Functional Health Literacy and Understanding of Medications at Discharge.  Mayo Clinic Proceedings. 2008.

Kripalani et al. Medication Use Among Inner-City Patients After Hospital Discharge: Patient-Reported Barriers and Solutions.  Mayo Clinic Proceedings. 2008.