Patients who choose less aggressive end of life treatment LIVE LONGER; Strong end of life planning overall (Advance Directives, palliative team planning, hospice, and POSLT/MOST system) is effective in reducing readmission rates as well as PATIENT SUFFERING.
Palliative care consults for high risk ED and ICU admissions have proven effective in lowering readmissions; when patients desire and are referred for hospice services, hospitalization rates in the subsequent 30 to 180 days are decreased by 40% to 50%
Sharon Silow-Carroll, Jennifer n. Edwards, and Aimee Lashbrook, reducing hospital re-admissions: lessons from top-performing hospitals, Health Management Associates, April 2011
Patients who have advance care planning spend 10 fewer days in the hospital during their last two years and have fewer readmissions than those without, as many elect to spend the time at home with family.
“Advanced Illness Management Strategies – Part 1” Web. 3 Nov. 2013
Demographics and Impact of Lack of Advance Care Planning (ACP)
Repeat ED and hospital admissions are often demographic and disease-specific. In one study from the New England Journal of Medicine, these facts emerged:
6% of Medicare beneficiaries were readmitted to the hospital within 30 days of discharge, and 34.0% were readmitted within 90 days.
Medical and surgical patients were both affected, though medical patients had a higher readmission rate (21.1% vs. 15.6% among surgical patients at 30 days) and accounted for 77.1% of those returning to hospitalization.
The highest 30 day readmission rates were observed for patients with heart failure (26.9%), psychoses (24.6%), recent vascular surgery (23.9%), chronic obstructive pulmonary disease (22.6%), and pneumonia (20.1%). During the last decade, risk-adjusted 30 day readmission rates among Medicare beneficiaries have remained relatively constant.
Boomers are Older, Sicker, and There are many more of them:
- The average national readmit rate for ICU is 7%
- 1 in 5 Medicare patients readmit within 30 days
- 1 in 3 Medicare patients readmit within 90 days
- 14-17% general population readmit within 30 days
- 30 day readmissions cost Medicare $12-15 billion
Source: Joynt KE, Jha AK. Thirty day readmissions – truth and consequences. N. Engl. J. Med. 2012;366:1366–9
If you can target “at risk” patients and give them resources to make medical decisions in advance, it will likely lessen ED/ICU utilization and 30 day readmissions.
Poor knowledge and misguided expectations lead to a lot of bad decisions.