Implementing Solutions for Hospital Readmission

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Thanks for the opportunity to assist with your posting. I will provide you with guidance on each section of the material. My doctorate is in this field and I also work in this field. As a result, my response will contain a combination of academic and real-world operational experience. Here goes.

An initial thought I would give you is to consider the RE-AIM framework when addressing this and other implementation problems. Information about RE-AIM can be found at www.re-aim.org, a site managed by Virginia Tech. At a high level, RE-AIM seeks to manage the implementation of clinical interventions by examining the "R"each of the intervention, "E"valuating the intervention, evaluating how well the intervention is "A"dopted, the actual "I"mplementation of the intervention, and "M" maintenance of the intervention. Based on the rubric you have provided in this posting, you can see how a framework such as RE-AIM is a nice way to wrap your responses into a central theme. Again, just a suggestion to think about. However, I think it shows you are thinking more about the theme and topic versus simply answering the question.

Before we get to the actual bullet points, I am sure you are aware the Affordable Care Act is about to levy reimbursement penalties on hospitals with higher than benchmarked preventable readmissions in three categories: acute myocardial infarction, congestive heart failure, and pneummonia. The penalty will initially be 1% of diagnostic related group-based reimbursements for Medicare patients, and will rise over the next three years. So, this is a big topic for hospitals. As for discharge planning, this is the likely culprit. Hospitals that do pre-discharge consultation with the patient, patient's family, and the full network of healthcare providers often have a better chance of keeping the patient in the ambulatory care setting versus having them come back to the hospital. So, I would argue you need such an intervention program to address this issue. I will try to answer the bullet points with that in mind:

Formal and informal leaders - The formal leaders of such an intervention are going to be those with "organizational power." This is power obtained from their position on the organizational chart. An example of an implementation of a discharge planning service would be the Nurse Manager for the unit in the hospital where the patient is located. Being a manager gives the position authority over the program. Informal leaders are going to ...