Focus on the patient reduces the risk of hospital readmission

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Care should take into account the characteristics of each person and their social vulnerability At the end of December, “The New England Journal of Medicine” published a wide range of material on the measures to be taken to reduce the chances of a patient being hospitalized again after being discharged, the so-called hospital readmission. The “recipe” is not difficult to guess: it is necessary to take into account all the characteristics of the person, including an assessment of their social vulnerability, instead of using the same metric for everyone. Focus on the patient reduces the risk of hospital readmission after discharge Fernando Zhiminaicela for Pixabay Corewell Health, a network that brings together 22 hospitals in the United States, mapped which patients were more likely to face recovery difficulties; then created a customized plan, according to the needs of each one. For the group considered vulnerable, a transitional support was set up lasting one month after discharge. In addition to the interdisciplinary approach, with professionals from different areas, the work was not limited to clinical challenges: interventions covered issues such as social determinants of health (for example, housing conditions). The result of the experience, which lasted for 20 months, could not be different: faster recovery of people and lower costs for the system that managed to avoid rehospitalization. Which leads me to quote another study on the role of hospitals in reducing inequality in health, if they start to evaluate patients taking into account their social needs, such as food insecurity, precarious housing, lack of access to transport, inability to paying basic bills and exposure to violence. To change the situation, the United States will take three steps to produce a more comprehensive view of the patient. The first goes into effect this year and establishes the hospitals’ commitment on five fronts: electing equality in health as a strategic priority; collect the patients’ sociodemographic information; analyze the material; adopt measures focused on remedying disparities in health; and, finally, to demand commitment from the leaders in this effort. The second and third steps will be consequences: the obligation for hospitals to report the percentage of adults who benefited from this approach and how many fit a vulnerable profile. It will certainly be necessary to standardize the measurement tools, qualify the institutions’ workforce for the project to work and oil the sharing of data for adjustments in public policies. I hope it works, although the necessary investments can become a big challenge. The blog enters a brief recess and the column will be published again on the 29th.

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