Habit Nicole F, Johnson Emily, Edlund Barbara J
Nicole F. Habit, DNP, FNP-C, completed her DNP program at the Medical University of South Carolina. She is now working as a Family Nurse Practitioner at Coastal Plain Hospital working with patients with chronic mental illness and substance abuse disorders. Her research focus is quality improvement for the psychiatric population to promote better patient outcomes. Emily Johnson, PhD, is an assistant professor at the Medical University of South Carolina (MUSC). She serves as a student mentor for capstone projects in a Bachelor of Science, PhD, and Master's in Clinical Research program at the MUSC. During this role, Dr Johnson mentored students in research design, data collection, statistical analysis, and dissemination of results. Barbara J. Edlund, PhD, ANP-BC, retired, is a professor at the Medical University of South Carolina. A faculty member of the Medical University of South Carolina since 1980, Dr Edlund currently teaches in the graduate and doctoral nursing programs. She has been funded nationally (HRSA) for the education of advanced practice nurses in Gerontological/Complementary Care, Adult Primary Care and Palliative Care, and distance continuing education for hospital nurses in rural areas of the State on the nursing care of the hospitalized older adult.
Prof Case Manag. 2018 Mar/Apr;23(2):70-74. doi: 10.1097/NCM.0000000000000248.
The purpose of this quality improvement project was to reduce 30-day readmission rates to inpatient psychiatric hospitals by standardizing discharge processes by including scheduling outpatient psychiatric appointments for all patients at discharge and also to include the mailing postal reminders to prompt patients to attend their first outpatient mental health appointment following treatment.
Inpatient psychiatric hospital.
The project design was an analysis of readmission data obtained both 3 months before and after implementation of the postal reminder letters. This project took place at a 50-bed inpatient psychiatric hospital in the southeastern United States that accepts male and female adult patients with mental health and substance abuse disorders.
The implementation of an appointment reminder letter resulted in a slight decrease in 30-day readmission rates. The average readmission rate 3 months prior to implementation was 10%. The average readmission rate 3 months postdischarge was 9%. December 2015 was included in the postimplementation data. December historically has higher rates of 30-day readmissions at this facility. If this month had been excluded, more dramatic decrease in 30-day readmission rates could be observed.
Future implications for case management practice could include the usage of reminder prompts via telephone communication or text messaging in conjunction with postal reminders. The psychiatric population can be particularly challenging when considering increased risk for readmission within 30 days and also the impending pay-for-performance quality measures, which are soon to be implemented. Measures should be taken now to ensure that readmission rates decrease, not only to promote better patient outcomes, but also as a cost-saving measure. Although many variables may contribute to the risk for 30-day readmission rates including medication noncompliance, lack of proper follow-up, as well as seasonal trends, the postal appointment reminder letters may further decrease 30-day readmission rates. Other care management strategies combined with reminder letters may further address barriers that may exist to not only improve patient outcomes, but also to further reduce readmission rates. It is also important to mention that there are further implications that could be directly contributed to specific social determinants of health specific to the psychiatric population. For example, access to prescribed medications and transportation to appointments should be addressed to further reduce readmission rates for this vulnerable population.
本质量改进项目的目的是通过规范出院流程来降低住院精神病医院的30天再入院率，具体措施包括在出院时为所有患者安排门诊精神科预约，并邮寄邮政提醒函，促使患者在治疗后参加首次门诊心理健康预约。
住院精神病医院。
项目设计是对实施邮政提醒函前后3个月获取的再入院数据进行分析。该项目在美国东南部一家拥有50张床位的住院精神病医院开展，收治患有精神健康和药物滥用障碍的成年男性和女性患者。
实施预约提醒函后，30天再入院率略有下降。实施前3个月的平均再入院率为10%。出院后3个月的平均再入院率为9%。2015年12月的数据包含在实施后的数据中。从历史数据来看，该机构12月的30天再入院率较高。如果排除这个月，30天再入院率的下降幅度会更显著。
病例管理实践未来的启示可能包括通过电话沟通或短信结合邮政提醒使用提醒提示。考虑到30天内再入院风险增加以及即将实施的按绩效付费质量措施，精神病患者群体可能特别具有挑战性。现在就应采取措施确保再入院率下降，这不仅是为了促进更好的患者治疗效果，也是一种成本节约措施。虽然许多变量可能导致30天再入院率风险，包括药物不依从、缺乏适当的随访以及季节性趋势，但邮政预约提醒函可能会进一步降低30天再入院率。其他护理管理策略与提醒函相结合，可能会进一步解决可能存在的障碍，不仅改善患者治疗效果，还能进一步降低再入院率。还需要指出的是，还有一些进一步的影响可能直接归因于精神病患者群体特有的特定健康社会决定因素。例如，应解决获取处方药和前往预约地点的交通问题，以进一步降低这一弱势群体的再入院率。
