Where patients recover may also
affect whether they wind up back in the hospital
by Rachel Nania, AARP,
October 25, 2019
Too many Medicare enrollees are being
readmitted to the hospital to be treated for the same infection they had while
they were inpatients, a new study shows.
Researchers at the University of
Michigan looked at more than 318,000 hospital discharge records
for Medicare patients 65 and older and found that 2.5 percent returned to the
hospital within a month to treat the same infection they left with — also
called a linked infection.
The study's lead author, Geoffrey Hoffman,
said that number may seem small, but “it should be closer to zero” when looking
at people having to be readmitted for something that's curable, like an
infection, compared to a condition that's chronic, such as heart
failure. Clostridioides difficile — a potentially deadly
germ that causes diarrhea, fever and stomach pain or nausea — was the most
common infection for which patients were readmitted; urinary tract infections
were the second. Both can be treated with antibiotics, “and you shouldn't have
to come back [to the hospital] for those,” said Hoffman, an assistant professor
at the University of Michigan School of Nursing.
The readmissions number “should be of concern
for hospitals and their infection prevention programs,” Hoffman added. “They
should make sure they're not just focused on the hospital stay, but also what
happens to the patient afterwards.”
Currently, Medicare provides financial
incentives to hospitals to minimize the number of infections patients pick up
during their stay. If a Medicare beneficiary gets certain types of infections
while they are in the hospital, the government won't pay the hospital to treat
it — and the patient doesn't have to pay, either. Extending such programs to
monitor whether infections persist once a patient is released may help to
reduce readmissions, Hoffman said.
Where you recover after a hospital visit could
also affect your chances for readmission, the researchers found. Patients who
go from the hospital to home — with or without home care — were 38 percent more
likely to return to the hospital with a linked infection than those discharged
to skilled nursing facilities.
"Skilled nursing facilities are typically
considered to be, if you will, dangerous places for picking up an infection,
and for spreading or transmitting infections to other patients … but we found
the opposite,” Hoffman said.
He explained that while these facilities do
struggle with high infection rates, they are likely better equipped to treat
them, “as opposed to someone on their own at home or at a home health care
agency where they may not have as structured of an infection control program.”
The findings indicate that hospitals should
consider sending patients with infections to skilled nursing facilities, and
not necessarily home, Hoffman said. “And then, if they are going to send them
home, maybe think about providing some more education or other needed
resources.”
Hospital readmissions are often viewed as a
quality indicator. If you leave the hospital and are “unaware of how to
optimally self-manage your condition,” you're more likely to end up back in the
hospital, Hoffman said. “And that's a signal of a gap in quality.”
But for older adults, hospital readmission can
also be a health hazard. Older patients are more likely to stay in bed and move
around less at hospitals, which, research shows, can lead to cognitive and
physical declines once they are released. They can also pick up infections.
Hoffman said the last thing he wants to do is
put more burden on patients and caregivers, but he recommends they “learn about
the risks that are out there.” He said don't be afraid to ask questions if you
don't understand discharge instructions; and if you are prescribed antibiotics,
make sure to follow the doctor's instructions on how to take them. Also, talk
to your hospital team about where would be the best place for you to recover
after a hospital stay.
"Just know that you really don't want an
infection to linger, and you don't want to go back to the hospital for it. You
want to treat that as soon as possible,” Hoffman said.
No comments:
Post a Comment