A hospital readmission rate can be a good proxy for the quality of a healthcare delivery system. Since every provider and caregiver within the clinical care continuum influences and impacts re-hospitalization, we can infer how well the system is performing overall. To effectively reduce hospital readmission rates, a holistic and efficiently integrated care management program is necessary.

The re-hospitalization rate statistic is used as an indicator for avoidable health care expenditures, as well as inefficient or ineffective quality care delivery systems. A 2011 study by Chollet, Barrett and Lake from Mathematica Policy Research indicated that healthcare expenditures related to hospital readmissions accounted for 16% of all expenditures on hospitalization. This is the primary reason why Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) have been promoting the Hospital Readmissions Reduction Program in addition to its value-based healthcare programs.

We recently evaluated our performance by calculating the hospital readmission rate for the cases we manage. The study found that our 30-day post discharge hospital readmission rate was 7% for all catastrophic cases managed between 2000 and 2014. Most importantly, our expert-driven and data-guided approach yielded a durable reduction in re-hospitalizations even at one-year post discharge from hospital care.

Using the national acquired brain injury (ABI) and spinal cord injury (SCI) model systems’ databases as our benchmark, Paradigm Outcomes’ hospital readmission rates for all reasons associated with our ABI and SCI patients were respectively 19% and 23% lower than the ABI and SCI model systems’ workers’ compensation group results at one-year post discharge.

One-Year Hospital Readmission Rate

Paradigm Outcomes supports our nation’s value-based and quality of care initiatives by continuing to monitor and investigate quality approaches and evidence based medicine over the entire care continuum. We believe the best clinical outcomes result from the highest quality care delivered over the entire care continuum. Our goal is to ensure the best clinical and functional results for catastrophically injured workers.

About the Author

Michael Choo, MD, is the Chief Medical Officer for Paradigm Outcomes. He maintains the company’s relationships with its network of consulting physicians and centers of excellence, and is responsible for enhancing clinical operations and leading clinical analytics, research and development. He also teaches emergency medicine, internal medicine, and family practice residents at Wright State School of Medicine.