Deborah Schuss’s op-ed in today’s Boston Globe illustrates the importance of putting the needs, concerns and capabilities of patients and family members at the center of care. Focusing on discharge procedures at hospitals, Schuss shares her belief that hospitals have lost “a genuine sense of caring to accompany the[ir] care”. This bold, uncomforting statement by Schuss arose during her own experience with a hospital’s new agenda.
The author talks about what happened when her dad was admitted to a hospital for treatment of pneumonia and an infection. The discharge process started before he was even admitted and the eventual discharge plan was incomplete, never taking into account, for example, the fact that her father couldn’t walk up his front steps, because the case manager assigned to his case never bothered getting this vital information.
Schuss recollects that not too long ago, a hospital social worker would meet with the family caregiver to plan the patient’s readiness for departure and post-hospital responsibilities. However, she argues that these days, a hospital case manager no longer works as the patient’s advocate.
Schuss highlights the frequent lack of communication surrounding a patient’s discharge from the hospital. A Commonwealth Fund study found that 18% of chronically ill hospital patients were readmitted to the hospital or went to the emergency room due to further complications after being discharged from the hospital.
There are initiatives in Massachusetts designed to reduce readmissions and make care more patient and family-centered. The Patient and Family Advisory Councils that all hospitals are required to establish by October 2010 will bring vital voices and perspectives to hospital care. Discharge planning is one of many areas that hospitals should bring before the Councils so that in partnership, the patients, families and hospital staff can ensure the needs of patients and family are met.
Massachusetts has also embarked on a project to directly reduce these so-called, “potentially preventable readmissions,” as part of cost control. A DHCFP study of discharge data has found that 377,000 hospital days in Massachusetts are due to readmissions that could have prevented. These preventable readmissions cost the system a staggering $577 million in 2006 (more details – pdf). The federal government has posted hospital-by-hospital information on readmission rates.
Massachusetts payment reform must serve as a complement to these ongoing initiatives so that all patients can receive more complete care.
-Shikha Jerath and Deborah W. Wachenheim
