Connecticut has saved an estimated $5.4 million in Medicare costs since 2010 by reducing re-hospitalizations of patients through a collaborative “communities of care” model in place in 14 regions around the state, including Hartford, New Haven, Milford, Meriden and Torrington. The estimate by Qualidigm, the state’s Medicare quality improvement organization, coincides with a study in the Journal of the American Medical Association (JAMA) that showed a marked decrease in both hospitalizations and readmissions of Medicare patients in regions where quality improvement organizations (QIOs) coordinate interventions that engage community partners to improve care after discharge. Hospital clinicians and their community partners in the 14 regions of Connecticut have stepped up “to find solutions (so that) patients are benefitting from enhanced coordination among providers across the care continuum,” said Dr. Mary Cooper, vice president and chief quality officer of the Connecticut Hospital Association, which is working with Qualidigm on the “communities of care” model. Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and expensive — occurrence. A new report published this week by the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 at reducing readmissions for elderly patients.
As a practitioner at Yale-New Haven Hospital, Dr. Leora Horwitz has seen her share of patients who misunderstand medication changes made during their hospital stays. Just recently, one of her female patients, who was switched to a new beta blocker for high blood pressure during an inpatient stay, landed back in the hospital after discharge because she had taken both the new medication and her old beta blocker – a combination that lowered her heart rate and blood pressure to dangerous levels. “Every physician can tell you about these kinds of errors,” Horwitz said. “We do a relatively poor job of educating patients about their medications.”
As a researcher, Horwitz can now quantify those lapses. A recent study she led looked at 377 patients at Yale-New Haven Hospital, ages 64 and older, who had been admitted with heart failure, acute coronary syndrome or pneumonia, then discharged to home. Of that group, 307 patients – or 81 percent — either experienced a provider error in their discharge medications or had no understanding of at least one intended medication change.
Two physicians, in Norwich and New Haven, have been reprimanded by the state Medical Examining Board for improper conduct connected to errors made during surgeries, while a third physician who had escaped Connecticut sanctions for out-of-state sexual misconduct also has been disciplined.