What happens when you look beyond the walls of your hospital?

Written by Stuart Dobbs, MD and Brenda Campbell

Hospital quality plans typically focus on measuring performance within the walls of the hospital – inpatient mortality, infections, falls, pressure injuries, etc.? One exception came from the Affordable Care Act of 2010 that required the establishment of a readmission reduction program. So why do hospital quality plans usually end at time of discharge? Mainly because it is difficult to access post discharge data.? If patients don’t come back to the institution for follow-up care, hospitals have limitations in monitoring.

Like most health care institutions, Houston Methodist celebrates quality awards.? Achieving awards is not our incentive or endpoint, but they help us track our quality methods year after year and in comparison to our industry. ?Mortality is an excellent example of a quality metric that is measured across various channels, including inpatient, post discharge and hospice status. By tracking and revising appropriate quality metrics, dashboards, and other relevant programs, we stay true to our goal of improving quality patient care across the continuum.

At Houston Methodist Hospital in the Texas Medical Center , our inpatient mortality statistics are excellent, but post discharge mortality and readmissions gained our attention.? We needed access to discharge data, with a focus on the first 30 days after discharge, so we collaborated with a unique predictive analytics company that could provide this data through Medicare claims information. Our post discharge mortality rates were about average compared to large academic medical centers, and most adverse events happened within the first 14 days post discharge.? Comparing our data to national data revealed similar outcomes – patients with follow-up visits within the first 14 days of discharge to home had lower mortality and readmission rates than those that did not.

What we learned is another reminder that what you don’t know, you can’t measure, and what is not measured, usually is not improved.

We understood that earlier follow-up appointments can improve quality, yet the resource limitation for follow-up care encouraged us to seek a solution that would prioritize patients in the timing of their follow-up visits. HealthVision, a real-time risk stratification model, was validated and integrated into our electronic health record, providing us with multiple risk algorithms.? Patients were stratified into quintiles and over 70% of patients experiencing readmission fell into the fifth quintile.? Using the 30-day readmission and 30-day mortality risk algorithms plus HealthVision’s risk stratification, we started targeting the patients who were being discharged home with and without home health services. Through this risk stratification, we initiated programs to schedule high risk patients with a follow-up visit (within 14 days or less) prior to their hospital discharge.

Using Medicare fee for service data, we established benchmarks for follow-up visits, mortality and readmissions and began tracking our outcomes.? Mortality and readmissions are measured using actual to expected. Comparing data from early 2023 to early 2024, our mortality rates dropped from 0.82 to 0.47, and readmissions dropped from 0.97 to 0.87.? Measuring follow-up care compliance and outcomes can be challenging but key to driving quality.?

It can be difficult to change the age-old paradigms that inpatient care ends at discharge. ?Patients move through multiple continuums of care and quality programs throughout their hospital stay and once they leave the hospital it can be challenging to trace their entire health journey. In conclusion, using risk stratification models can assist organizations in prioritizing care based on the unique needs of patients while managing limited resources.?