WSJ Article -Programs To Prevent Hosital Re-Admissions

Can a virtual nurse named Louise help keep patients from landing back in the hospital after they are discharged?

By Laura Landro
Wall Street Journal

Louise walks hospital patients through plans for their recovery at home.

It's part of a push to reduce the 4.4 million hospital stays that are a result of potentially preventable re-admissions, which add more than $30 billion a year to the nation's health-care tab, or $1 of every $10 spent on hospital care, according to the federal Agency for Healthcare Research and Quality.

With hospital stays shorter than they used to be, patients may be sent home in frailer states. They may not understand instructions on how to take care of themselves and face unexpected medical problems after leaving the hospital. More than a third of patients don't get the lab tests, specialist referrals or follow-up care they need.

With one in five of its elderly hospital patients re-admitted within a month of discharge, the federal Medicare program plans next year to reduce how much it will pay hospitals for certain preventable re-admissions. In April, Medicare announced it will provide $500 million in grants for organizations that work with hospitals on programs to reduce re-admissions. The government is funding an effort to help hospitals adopt Project RED, a discharge-planning program developed by Boston University that helped cut re-admissions at Boston University Medical Center by 30% in a 2008 study. Researchers there have developed the "virtual discharge advocate," Louise, to help explain home care to patients.

Re-admissions often occur because of poorly communicated instructions, such as when a rushed staff member hands a pamphlet or a printout with scant information to a patient or relative. "I got more instructions on how to take care of a goldfish I took home from the pet store as a kid than we give some people we send home from the hospital," says Victor Caraballo, senior medical director of Independence Blue Cross in Philadelphia. It is providing $5 million to a patient-safety initiative involving more than 70 hospitals and aiming to reduce re-admissions by 10% by next spring.

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Correction & Amplification
The portion of Medicare patients who are readmitted within a month after a hospitalization is 20%, or one in five. An earlier version of this article incorrectly said that one in 20 end up back in the hospital.