Nurses are the Key to Reducing Revolving-Door Readmissions

Shockingly, one in five elderly patients discharged from a hospital is readmitted within a month. Seeking to address the substantial human and financial burden of revolving door hospital readmissions, the Affordable Care Act has proposed a number of initiatives to improve care and health outcomes and reduce costs for the growing population of chronically ill people in the U.S.

While transitional care is a central theme in these provisions, there is little information available to guide those responsible for implementing these important opportunities. To bridge the gap, researchers at the University of Pennsylvania School of Nursing reviewed existing programs in order to determine what works, for whom and for how long.

They discovered “a robust body of evidence” that transitional care can improve health outcomes and reduce hospital readmissions. Their paper published in a recent edition of Health Affairs, highlights a range of solutions to reduce avoidable hospitalizations and health care costs.

The team conducted a systematic review of the research literature and summarized twenty one randomized clinical trials of transitional care interventions targeting chronically ill adults. From these, they identified nine interventions that demonstrated positive effects on measures related to hospital readmissions. “All nine interventions that showed any positive impact on readmissions relied on nurses as the clinical leader or manager of care,” wrote lead author Mary Naylor, Ph.D., R.N.

The strategies they identified have been shown to result in short term benefits and effectively reduce all-cause hospital readmissions through six or 12 months. “If we capitalize on what we know, the real beneficiaries will those living with complex chronic conditions and their family caregivers,” explained Naylor.

This makes sense to us and is certainly a lot easier than trying to understand the Affordable Care Act.

From Silver Ball to Silver Tsunami

2011 marks yet another milestone for America’s Baby Boom generation, one they are not likely to welcome.

It’s estimated that there were 76 million Americans born between 1946 and 1964, meaning the first of the baby boomers will turn 65 this year, and the rest won’t be far behind.. Analysts predict the number of people age 65 and older will double between 2010 and 2050. During the same period, the number of those 85 and older will increase four fold.

No wonder it has been dubbed the “Silver Tsunami.”

According to urban legend, baby boomers are associated with a rejection or redefinition of traditional values; privilege, as many grew up in a time of affluence. As a group, they were considered the healthiest and wealthiest generation and amongst the first to grow up genuinely expecting the world to improve with time.

Now the boomers are getting old, people are asking: will the country be ready to meet their extraordinary medical and social needs?

The answer, according to geriatric experts at the University of Alabama at Birmingham, is no.

As time passes and the boomers continue to age, they will need specialized geriatric care from specialized health care professionals in specialized facilities.

National estimates cite approximately 7,000 geriatricians currently certified to care for the rapidly growing boomer population,” said Richard Allman, M.D., Professor and Director of the UAB Division of Gerontology, Geriatrics and Palliative Care. “Yet our society will need more than 20,000 geriatricians to accommodate the increasing demand for specialized care.”

And it’s not just doctors.  Allman, who is also director of the Birmingham/Atlanta Veterans Administration Geriatric Research, Education and Clinical Center (GRECC) and the UAB Center for Aging, says the need for specialized caregivers for geriatrics extends beyond physicians to include nurses, therapists, dietitians, social workers and community caregivers.

And these are the boomers we’re talking about – traditional models of old age just aren’t going to cut it. Andrew Duxbury, M.D., a UAB geriatrician, suggests that the average boomer who reaches 65 in reasonable health will live into their 80’s or early 90’s, and more importantly, remain healthy and active well into their 80’s.

The boomers have always gotten what they want when they want it, with the demographic numbers to push society to accede to their demands,” he says. “They are not a generation to sit back and let history roll over them. They’ll go out and make their own history.”

He suggests that demand for such things as joint replacements, medications to improve aches and pains of aging and bypassing of clogged arteries will all skyrocket. Duxbury says the boomers will want the system to work around them and their active lifestyles and will not put up with all-day visits to the doctor. They won’t be sitting around playing shuffle board at the retirement center.

The boomers, with their health and vitality relatively intact into older age, will completely change how Americans conceive of what it means to be old,” Duxbury points out.

Allman says there is no public policy issue of greater importance than aging, nor one that is more ignored.

And there is work to be done in other fields besides medicine. Architects and engineers will need to design products, buildings and transportation facilities that are appropriate for an aged society. Educators will need to plan how to train people in mid career to do new tasks and use new technology in order to be affective workers. Businesses are going to need older workers to keep their enterprises going.

The last boomer will not die until sometime around 2080” says Duxbury. “They will be with us a long time.

So, whether you’re a boomer, or involved in planning healthcare for the aging boomer generation, SRxA’s Word on Health would love to hear your radical ideas on how best to address this issue.