Wednesday, July 13, 2011

Reducing Hospital Readmissions

Amy E. Boutwell, MD, President, Collaborative Healthcare Strategies, a presenter at the “Health Affairs” briefing on July 7th at the National Press Club, discussed the available data on the “State Action on Avoidable Rehospitalizations” (STARR) initiative included in the July issue of the Health Affairs Journal.

STARR is a project of the Institute for Healthcare Improvement, supported by a grant from the Commonwealth Fund. The resources from the grant support partnerships among hospitals and their community-based partners and today, four states, Massachusetts, Michigan, Washington and Ohio are mobilizing state-level leadership to improve care transitions.

The key findings report that after two years into its four year cycle, the initiative has 148 hospitals working in partnership with more than 500 cross-continuum team partners. The teams review events associated with rehospitalizations, identify their causes, develop strategies to improve patient education, provide timely follow-ups with patients after hospital discharge, and create universal transfer or discharge forms. Boutwell and her co-authors did find that more than 90 percent of participating hospitals with teams do routinely review rehospitalizations with their community-based colleagues.

Hospitals participating in Ohio’s STARR initiative contribute to the state funding model with the promise of reimbursement if they adhere to the initiatives core methodology. This approach has proved successful in encouraging participation.

One of the common challenges facing STARR is data collection since none of the four states have access to state-wide data on rehospitalizations. Other challenges include engaging hospital executive teams so that current and future financial analyses can be done on the impact of readmissions on their operations. However, three of the original states have used local solutions to best access available state-wide rehospitalization data reports.

The coauthors recommend that efforts to reduce rehospitalizations must go beyond the walls of a hospital if they expect to reduce rates sustainably without the explicit partnership of community- based providers. Secondly, state leaders should consider forming a state-level, multi-stakeholder entity that can ignite action, generate momentum, and leverage networks to increase interest in and visibility of a common aim. Finally, incentives and updated payment policies are needed to support the investment needed to deliver coordinated care across settings.

For more information, go to or email Amy Boutwell at