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In any profession today, quality control means the prevention of problems that were the aim of the business to solve in the first places. Recurrence of these problems means that the business has not been functioning optimally and a new strategy or focus is required. In the health care setting, such a challenges is presented by hospital readmissions. When a person is discharged from hospital after receiving treatment for a certain condition, this means that the aim to persuade the patient with a remedy for the condition was reached. Readmission for the condition at some future date means that the remedy was not sufficient and a different strategy needs to be followed. There are several focus points when considering the readmission of patients to hospital and how this can be prevented. Upon final analysis, it is indeed possible to prevent this and the health care professional has an obligation to follow protocols that have been put in place to accomplish such prevention.
Minot (2008) points towards the possibility that, although many readmissions can and should be avoided, it should nevertheless not be the aim to avoid readmission at all costs. Some conditions, for example, require repeated treatments, and failing to readmit patients with chronic conditions is not only dangerous, it is also irresponsible. A person with cancer, for example, would receive intermittent treatments without which most such patients would die.
On the other hand, however, Minot also notes that many readmissions can and should indeed be prevented. This category of patient includes those with one-time conditions that should be treated once and prevented from occurring in the future. Such patients benefit not only from initial treatment, but also from counseling on how to retain their health in the long-term and thus prevent readmission for the same condition. The seriousness of the condition also plays a role. Persons with heart failure, for example, needs particularly close attention with regard to preventative measures. Even when sufficient counseling is provided, the condition often does result in rehospitalization. This is detrimental not only for the economy, but also for a patient's general sense of well-being and health, which also impacts more specific health concerns. In the interest of all parties, it is therefore desirable to, where possible, reduce readmissions.
In addition to focusing on readmissions as a costly problem for the United States and its health care system, Sims and Hadi (2011) also suggest that certain populations are most vulnerable, with specific focus on senior citizens. This is a significant concern, since the Western world is gradually ageing, with fewer births and a death rate at a much higher age than has ever been the case in human history. This has a significant effect on the health care system and the way in which readmissions should be conceptualized. According to the authors 20% of Medicare patients are being readmitted within 30 days after discharge. In 2012, the readmission policy in terms of the economy has become to penalize hospitals that show a higher admission rate by offering lower reimbursement rates for these hospitals. Hence, in the interest of both patient and health care provider, it is a reasonable aim for hospitals to, as far as possible, reduce unnecessary readmissions.
For senior citizens, Sims and Hadi (2011, p. 3) suggest modern electronic means such as video chat. This follows the authors' finding that follow-up communications with health care providers is one of the key factors that affect senior citizens and their readmission to hospitals. Hence, the concept of video chatting was used to design a device to specifically help senior citizens communicated with their health care providers without the cost and effort of a physical hospital or office visit. A simple touch-screen user interface formed the basis of the device, which was dubbed "Touch." In terms of appearance, the device could also be used as a picture frame when not being used. In this way, senior citizens are provided with a device that easily and immediately connects them with a professional or family member to answer questions or help with strategies to prevent unnecessary readmission to hospitals. From the health care perspective, this device is also highly beneficial to professionals themselves, since the time and cost investment involved in office visitations is reduced in this way.
Gonseth et al. (2004) also focus on older citizens, but those suffering from specific conditions such as heart failure. The authors investigate the effectiveness of enrolling these citizens in disease management programs in order to reduce the likelihood of readmission. Such programs have several positive impacts; it offers senior citizens the opportunity to communicate not only with health care providers, but also with each other regarding their condition and its challenges. This can result not only in practical support, but also in valuable emotional support. Emotional support is vital in terms of a holistic view of healing, where the link between body and mind can often mean the difference between illness and continued health. Older people, who often feel vulnerable and lonely, are particularly prone to self-induced relapses, even on a subconscious basis, to ensure continued or prolonged human contact. Disease management programs would eliminate the perceived need for human contact by being readmitted to hospital. The effective implementation of such programs is vital, since the authors point towards heart failure as among the leading causes for hospitalization among the elderly. The practical, social, and emotional support of disease management programs can go a long way towards at least preventing relapses and readmissions to hospitals.
Practical, emotional, and social support is particularly important in the case of nursing homes, where groups of older people can be managed in such a way as to encouraged their own health care management. Gleckman (2012), for example, points out that there are significant health dangers involved in readmissions to hospitals when it comes to senior citizens residing in nursing home facilities. As a result of the particular set-up of senior care, there is an increased danger of risk factors such as delirium, medication errors, falls, and infection. These factors can result in readmissions, which are entirely preventable with the necessary focus on post-discharge care. Indeed, when senior citizens in care are part of a targeted disease management program that involves helping them take control of their own health, the likelihood of greater health improves almost exponentially.
Gleckman (2012) shows that not only hospitals, but also nursing homes in conjunction with hospitals have shown great success in helping their senior charges to prevent unnecessary readmissions. Specific strategies by nursing homes that have proven successful include improved training for staff, nurses, and aides to identify danger signs and threat factors to prevent dangerous situations rather than having to treat them after they have occurred. Communication strategies among residents, staff, and nursing professionals has received particular attention in creating success for these strategies.
Another strategy is alliances with primary care doctors and the ability to trust the nursing facility to treat their patients within the nursing home itself rather than readmitting them to hospital when this is not strictly necessary. Again, accurate and targeted communication forms a vital component in this.
Finally, patients, residents, and their families play a vital role in making a success of the communication process. Through communication, it is determined whether patients want to be hospitalized for their conditions. It was found that many would prefer to be treated at their residences, which means a greater sense of well-being and control while also ensuring fewer hospital readmissions.
Daly et al. (2005) also focus on disease management programs and their potential to reduce hospital readmissions, with a slightly different focus group in terms of the "chronically critically ill." While both heart failure and the elderly certainly make up a large part of this population, the focus here is upon the severity of the condition. It has been mentioned that chronic illness often not only cause, but also necessitate, hospital readmissions, which means that these are often regarded as inevitable. The authors appear to hypothesize that such perceived necessity is not necessarily always accurate.
Daily et al. (2005) define "chronically critically ill" patients as those admitted to hospital and in need of treatment involving prolonged intensive care admissions and mechanical ventilations. These patients tend to be subject to a high level of both morbidity and mortality after being discharged from hospital, which means an increased risk of hospital readmissions. The authors use the basis of empirical evidence in terms of persons with single disease diagnoses to hypothesize at least some level of success when using disease management programs for patients with multi-disease diagnoses, and particularly for those who are diagnosed as chronically critically ill. It is hypothesized that both the coordination and efficiency of care after discharge can be improved for these patients as well, thus reducing the likelihood of readmission. The authors found that the use of disease management programs could reduce readmissions for those suffering from chronic conditions such as asthma, diabetes, and heart failure by as much as 25%.…[continue]
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