Primary Care: the New Frontier for Reducing Readmissions
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The Gehr Family Center for Health Systems Science & Innovation, Keck Medicine of USC, Los Angeles, CA, USA; 2John Snow, Inc., Boston, MA, USA.
To date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, we examined the literature focusing on primary care–based efforts to reduce readmissions. While rigorous studies on interventions arising from primary care are limited, we found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most promising. However, policy changes are necessary to spur innovation and support effective primary care–led transitions interventions. Though more rigorous research is needed, our findings suggest that primary care can and should lead future efforts for reducing hospital readmissions. KEY WORDS: primary care; health care delivery; primary care redesign. J Gen Intern Med DOI: 10.1007/s11606-019-05428-2 © Society of General Internal Medicine 2019
primary care ought to serve a more prominent role in care transition efforts.6 Yet there are few concerted efforts underway to develop, implement, and assess primary care–based transitions programs. In a recently published environmental scan commissioned by the Agency for Healthcare Research and Quality (AHRQ), we assessed the current state of the literature on primary care– based care transitions programs.7 We identified numerous peer-reviewed and non-peer-reviewed studies ranging from narrow interventions to more comprehensive multicomponent initiatives. While some of the included studies had methodological limitations (there were few rigorous controlled analyses), collectively, they shed light on the types of interventions that are likely to be successful, revealing practical considerations and policy changes needed for making these initiatives sustainable. In this piece, we summarize insights from the environmental scan and make a case for an enhanced and expanded role for primary care in the care transitions process.
rates of hospital readmissions are a persistent probH igh lem in the USA. Widespread efforts to implement
BUNDLED VERSUS SINGLE-COMPONENT INTERVENTIONS ARE MORE LIKELY TO SUCCEED
hospital-based care transitions programs, such as RED (Reengineered Discharge) and others, have garnered considerable attention and have yielded favorable results over the past several years.1–4 While hospitals continue to refine their readmission reduction efforts, their ability to control what happens after discharge and outside of their walls remains limited. With recent estimates suggesting that approximately a quarter of hospital readmissions may be avoidable, it is essential for us to pursue new approaches to address gaps in the care transitions process.5 One area ripe for exploration is primary care–based initiatives, which to date have received less emphasis. Many successful hospital-based programs involve the coordination of post-discharge ambulatory services, bu
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