Implementing and Evaluating the Hospital Guide to Reducing Medicaid Readmissions
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The document outlines a project by AHRQ and JSI focused on implementing and evaluating a guide designed to reduce Medicaid readmissions in hospitals. It details the evaluation process, which includes a mixed methods approach and research questions aimed at assessing the guide's feasibility, adoption, and impact. Preliminary findings indicate positive feedback from hospitals on the utility of the guide and tools, with varied adoption of strategies to address readmission rates among Medicaid patients.
Implementing and Evaluating the Hospital Guide to Reducing Medicaid Readmissions
- 1. Implementing and Evaluating the Hospital Guide to Reducing Medicaid Readmissions Angel Bourgoin, PhD, James Maxwell, PhD,Amy Boutwell, MD, MPP, Katie DeAngelis, MPH, Sarah Genetti, BA,Alyssa Thomas, BA Background Methods Initial Results Significance Reducing readmissions is a growing priority in the pursuit of the Triple Aim.While much attention has been paid to Medicare readmissions, evidence demonstrates that Medicaid adults have the highest readmission rates of any payer. Some Medicaid agencies are increasingly implementing payment penalties for readmissions, and the recent expansion of Medicaid eligibility under the Affordable Care Act has provided millions of adults with new health coverage. Hospitals serving large numbers of Medicaid patients have a mounting interest in adopting strategies to reduce readmissions that address the distinct needs of this population. The Guide In 2014, the Agency for Healthcare Research and Quality (AHRQ) published the Hospital Guide to Reducing Medicaid Readmissions. This Guide, along with 13 tools, walks hospitals through the process of analyzing their readmissions data, taking an inventory of their readmissions efforts, and developing a portfolio of strategies that includes hospital-based transitional care strategies, cross-continuum team partnerships, and enhanced services for high-risk patients. The Project AHRQ has contracted with JSI to disseminate, implement, and evaluate the Hospital Guide to Reducing Medicaid Readmissions. JSI is currently working with six hospitals in Illinois and Maryland to identify how the Guide can be improved and supported in future implementation, and evaluate its effectiveness in reducing readmissions. Evaluation Design The evaluation uses a mixed methods approach, with quantitative data on outcome measures, as well as qualitative data to offer additional context and detail. JSI will document the hospital implementation progress, experiences in implementing the Guide, and outcomes of implementation through three surveys (pre-implementation, post-implementation, and post- sustainment) and through ongoing calls with hospitals throughout the project. Participating hospitals will provide monthly Medicaid readmissions data for the project period, as well as 12 months prior for comparison. The Intervention The timeline below shows the duration and sequence of activities that hospitals will participate in during this project.The intervention is composed of a 7 month implementation period and 6 month sustainment period.The implementation phase includes 1) participation in a learning collaborative hosted by participants’ respective hospital associations that introduces them to the Guide, and 2) biweekly one-on-one calls between the project team and hospitals for mentored implementation, culminating in an in-person learning session. Hospitals are not expected to implement every strategy mentioned in the Guide, but to select those strategies that will be germane to the findings from their data analyses and current efforts and resources. Hospitals will continue implementing their readmission reduction strategies independently during the sustainment period. Research Questions In order to understand the utility of the Guide and improve upon it, the evaluation is guided by three research questions: • RQ1. Feedback. – How feasible and useful are the Guide’s tools and strategies to hospitals? What areas of improvement for the Guide do hospitals and other stakeholder audiences identify? • RQ2.Adoption – To what extent did the implementation hospitals adopt tools and strategies from the Guide over the implementation period? What factors affect their adoption of tools and strategies? • RQ3. Impact – What is the impact of the adoption of the Guide’s strategies and tools on Medicaid readmissions and related outcomes? What factors influence their effectiveness? At this point in the project, there are some promising findings with regard to feedback and adoption of readmission reduction strategies: • Feedback. Hospitals have responded very positively to the Guide and tools, describing them as useful for spurring and guiding improvements to their readmission reduction efforts. Some recommendations for improvement were to offer increased guidance for specific staff roles in using the Guide, more cohesion between the Guide and tools, and content/format changes that would allow greater ease of use. • Adoption. Hospitals have varied widely in terms of the strategies they have pursued, ranging from a focus on hospital-based care transitions for all patients to developing emergency department- based care plans for high-utilizers. The portfolio development tool was especially useful in planning which strategies were of highest priority, which could then be communicated to senior leadership. Each hospital has made progress on their selected strategies during the mentored implementation period, and are anticipated to make continued progress during the sustainment period. A final report, presentation, and revised Guide are expected Summer-Fall 2016.‘ This project is funded by AHRQ (Contract No. HHSA290201000034I). The driver diagram below, taken from the Guide, illustrates how the six sections of the Guide work towards the objective of reducing readmissions among Medicaid patients.