Developing partnerships with community groups required a new way of thinking, Dr. Genden said. For example, the treatment paradigm needed to extend beyond the academic center, because this should only amount to a small portion of time in the patient’s cycle of care. Most of the time, patients receive radiation chemotherapy and surveillance in the community. “By doing this, in addition to increasing communications with physicians, the patient receives better care that is much more cost effective,” he added.
Explore This IssueOctober 2015
The center also instituted the Patient First Program, in which a physician assistant or member of the nursing staff interviews every patient before he or she is seen at the cancer center to understand co-morbidities, social barriers, and financial barriers. Subsequently, these obstacles can be managed early on in the care process. Potential risk factors for readmission are identified and tackled.
A third approach involves the center forming hospital-wide readmission committees. These working groups are designed to identify patients at risk for readmission, including those with high-volume co-morbidities, those with highly complex diseases such as head and neck cancer, and patients who have less than ideal support at home and less than ideal access to community care, pinpointing patients who may have been missed in the Patient First Program process. The working group assigns these patients to community physicians and suggests community support resources to prevent them from being readmitted to the hospital.
In reviewing its readmissions, the Head and Neck Institute at Mount Sinai Health System determined that approximately 80% could have been avoided if problems had been managed in the community earlier in the process. Combining the three approaches has decreased the number of hospital visits from 2.7 to 1.3 per patient, largely because much of the workup and evaluation is coordinated with the patient before a visit, Dr. Genden said.
Using a Pre-Admission Clinic
Dr. Dziegielewski believes that preventing hospital readmissions begins with the decision for surgery and continues through the hospital stay and the post-discharge period. “By having patients attend a pre-admission clinic, readmissions can potentially be prevented,” he said. In fact, a study by Dr. Dziegielewski and his colleagues showed that patients who did not attend a pre-operative clinic had an eight-fold greater chance of a 30-day readmission (Head Neck. Mar 9, 2015. doi: 10.1002/hed.24030).
“The clinic performs a battery of baseline laboratory and imaging tests to screen patients for correctable issues before surgery,” he said. “It also directs patients to appropriate medical subspecialists for optimization of chronic medical conditions during the perioperative period.” The clinic also employs an anesthesia team member who plans ahead for complex procedures, such as a free-flap case.