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Ankota: Home Care Next Generation Blog

Community Demographics are a Key Indicator of Care Transition Success

Ankota recently hosted Dr. Marc Greenwald on our monthly webinar on Care Transitions Best Practices.  Dr. Greenwald shared his experiences from running successful care transitions programs in several Massachusetts hospitals.  It was a well-attended and very informative webinar.  If you if missed our live broadcast, you can watch the recording here.

One of Dr. Greenwald’s key observations from working in urban and rural hospitals, and in different socioeconomic situations, was that these community factors are a key indicator of care transition success.  Well, he was right.  A recent study in Health Services Research and described in an article entitled Community Demographics Linked to Hospital Readmissions on the Center for Advancing Health website (www.cfah.org)* confirms Dr. Greenwald’s observations.

The article summarizes the following two takeaway points from the study:

  • Nearly 60 percent of the variation in hospital readmission rates appears to be associated with a hospital’s geographic location.
  • Counties with more general practitioners and nursing homes had lower rates of hospital readmissions.

Data from the Committee for Medicare and Medicaid Services (CMS) was collected for 4,073 hospitals in 2,254 counties and covered the period from July 2007 to June 2010.  Key conclusions were as follows:

  • 58 percent of the variation in 30-day readmission rates was at the county level, before any information about the type of hospital or county was taken into account
  • This leads to the conclusion that individual hospital performance may account for only 42 percent of the variation in readmission rates

The lead author on the study, Jeph Herrin, Ph.D., senior statistician with Health Research and Educational Trust, shared that “the biggest surprise was how much affect the county or the community had on readmission rates.”  He also shared that "Hospitals in the same area had similar readmission rates as others in the area” showing that community has a bigger impact than specific hospital.  This is consistent with a recent NPR story on high readmission rates at Beth Israel Deaconess hospital in Boston (see more about this story here).

As the US health system moves to the “Accountable Care” model, there will continue to be more and more need for care coordination between providers, and in our editorial opinion, a greater need for collaboration between hospitals and home care.  Home care is uniquely positioned to bring nursing and health aide skills to the patient’s home and as the model matures, more reliance on home care to prevent individuals from becoming patients.

Ankota offers software to help manage care transitions from hospital to home and to avoid 30-day readmissions.  We’ve designed the software for organizations like home health agencies to accept referrals from multiple hospitals in their geographic community.  As it relates to the story above, having consistently strong care transitions capability for a community, independent of referring hospital, appears to have the potential for positive outcomes.  To learn more about the care transitions opportunity, go to www.ankota.com/care-transitions.  If you’d like a demo of the software, press the button below.

 Click to Learn how to Increase Profit via Care Transitions

*Note: The article draws copyrighted information from Health
Behavior News Service, part of the Center for Advancing Health.

white paper describing care transition readmission avoidance opportunity     home care best practices

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

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