In a study, student social workers helped decrease the average of readmission at a hospital.
“Obviously, if you send someone home from the hospital, you don’t want them to come back,” says Susan Troccia, director of coordinated care at Gwinnett Medical Hospital in Lawrenceville, Ga.
Rehospitalization rates are surprisingly common, though, especially among elderly Medicare patients, where the national average of readmission within 30 days of discharge is about 19%. That’s almost 1 in 5 Medicare beneficiaries.
While readmissions negatively affect patient quality of life, they also cost Medicare about $17.5 million per year.
Due to the extent of this problem, the Affordable Care Act Section 3025 proposes to penalize hospitals that have excessive readmission rates, and Medicare has decided to penalize 71% of hospitals for which rates have been evaluated, according to Kaiser Health News.
The penalties will increase in October, so many hospitals are scrambling to find and test solutions, to learn how they can prevent rehospitalizations.
Laura Bronstein, a professor of social work at Binghamton University in Upstate New York, designed a study with Shawn Berkowitz, director of geriatrics at United Health Services (UHS) and clinical assistant professor at SUNY Upstate Medical University to examine how student social workers can decrease readmission rates.
In the study, patients were evaluated by a LACE index, which examines several criteria to determine risk of rehospitalization. Students would meet with eligible patients while they were still in the hospital, and the patients would be placed either into the control group, where they received standard care, or in the experimental group, where students followed up post-discharge. Students made phone calls to schedule home visits, and then would phone again to check in after the visit.
In the preliminary findings, eight patients out of 44 (18.2%) in the control group were readmitted within 30 days. No patients in the social work intervention group were readmitted, showing significant improvement.
In an analysis performed at UHS, Bronstein says they found that “even if the hospital hired a dozen social workers they would still make great savings in the readmissions that they potentially averted.”
Berkowitz says that if other hospitals can duplicate the model they’ve created, it will save hundreds of thousands, if not millions per year, and that social workers need only prevent seven rehospitalizations per year to pay for their own salaries.
“Readmission programs are abuzz right now, but they’re relatively expensive, so it was really interesting to me that (Bronstein) used social workers … and that they did it with relatively low costs,” says Troccia, who met with Bronstein earlier this week to discuss logistics of establishing a similar program at Gwinnett Medical Center.
While the model is geared toward elderly patients, people in a wide variety of circumstances get readmitted, and the model could be applied to fields other than geriatrics.
“Sometimes younger people readmit more because they don’t have insurance,” says Troccia, who adds that even patients with insurance readmit for various reasons, like not having transportation to appointments or being embarrassed to ask for help.
The UHS interns helped pinpoint what patients needed during their post-discharge care, from navigating checkups to understanding their treatment plans.
Cyrilla Suker, an intern during the study, is now a social worker at Mount Sinai Medical Center in Manhattan, where there is an outpatient program similar to Bronstein’s. Suker says many patients just needed emotional and verbal support.
“I think the most valuable part was that you saw different perspectives. We met with patients while they were in the hospital, where they had all the support that they needed, and when we did home visits, you saw them in their home environments, and you were able to grasp what else they might need,” says Suker.
Kris Marks, manager of clinical social work at UHS and supervisor of the students during the study, agrees the students provided a “tremendous amount of support and empowerment.”
While Bronstein used social work students in the model, it could be manipulated in several ways.
At UHS, “what we proposed is (making) the social work team part of the staff, so it would be something that we would recruit for and hire for. I think that would be an ideal scenario … rather than being contracted out,” says Marks.
“Being outside of Atlanta, we have students a lot, and work with the universities, so (Bronstein’s model) seems like something that we could replicate,” says Troccia.
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