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Can We Reduce Readmissions for Patients with Multiple Chronic Conditions?

In 2012, newspapers around the country reported on a major finding from the Canadian Institute for Health Information (CIHI). At the time of publication, one in 12 patients were readmitted to hospitals within 30 days of discharge.

This figure sounds high – and it is. But for many health care professionals, it didn’t come as a shock.

Ensuring proper support for at-home patients has always been a massive challenge. And as the number of Canadians living with multiple chronic conditions grows, this challenge is only intensifying.

We all know that caring for someone living with three diseases is bound to be more complicated – and costly – than caring for someone who has just one. That said, many seasoned health care providers are surprised to learn just how big the economic impact of multimorbidity can be. Hospital readmissions are a major driver of these costs.

At a time when the impact of chronic diseases is growing, can health care leaders and coordinators really reduce hospital readmissions?

Multiple Chronic Conditions: an Epidemic

If there’s one thing most health care professionals see the impact of every day, it’s chronic disease. Whether you’re a sector decision-maker, a care coordinator, or a frontline worker, you’re aware of the toll these conditions can take.

Poor health outcomes and quality of life for patients. Exhausted family caregivers. Overworked and burnt-out workers – especially in the home care sector. And of course, high costs to the health care system.

It goes without saying that not every patient with diabetes or arthritis requires constant care. Chronic conditions can, in many cases, be highly manageable. But as the number of diseases a person has goes up, her dependence on the health care system usually increases, too. And so does the complexity of care she requires.

Consider how complications increase when there are many physicians and caregivers involved in a patient’s care. Think about the cautiousness required when dealing with someone who’s receiving multiple medical treatments or medications.

More and more, care plans are becoming complex. And the costs associated with carrying them out are increasing, reaching levels never seen before.

This trend shows no signs of slowing – and it’s incredibly widespread. Consider the following statistics.

  • CIHI has reported that seniors with three or more chronic conditions use three times more health care resources than those with none. They also report almost three times as many visits to emergency rooms as those who have one chronic condition.
  • In Ontario, two out of every three health care dollars goes toward people with multiple chronic conditions.
  • In the United States, 71% of health care spending is associated with caring for patients with multiple chronic conditions.

Let’s take a look at one of the costliest consequences associated with chronic disease – hospital readmissions.

A Look at (Staggering) Readmission Rates

The link is clear. And now there’s evidence to support what health care leaders, coordinators, and frontline workers have always known. Those with multiple chronic conditions are more likely to be readmitted to the hospital.

Consider this recent study. The results show that American readmission rates are higher in areas where people with multiple chronic conditions are clustered.

Of course, it’s not just the number of multimorbid patients that matters. In places where there’s a large proportion of these patients, caring for them in the right way will make a difference. Health care leaders can start by looking closely at the regions where readmissions are high.

Unfortunately, Ontario has fared especially poorly in recent years. Between 2009 and 2014, the provincial rate of readmission rose from 8.3 to 9.1%, the largest increase in the country during this period.

This rise is telling. As the province makes the transition to a more home-care based system, care coordination issues are escalating. Doctors, nurses, personal support workers (PSWs), pharmacists – these professionals are learning to work together efficiently outside of traditional care environments. And they’re doing so while caring for increasingly complex, multimorbid patients.

It’s no wonder readmissions are high. And the costs are really adding up.

According to the study mentioned at the beginning of this post, over an eleven-month period, national readmissions totalled $1.8 billion.

Needless to say, containing health care costs will mean curtailing readmission rates. Changing the way we care for patients with multiple chronic conditions will go a long way toward reaching this goal.

Making a Difference: Change is Possible

Ontario has taken steps to improve the health and quality of live of patients with multiple chronic conditions. Solutions that meet these goals also reduce the negative societal impacts that caring for multimorbid patients can have – such as hospital readmission costs.

Moving forward, Health Links is sure to bring about significant improvement. Some of the initiative’s aims are already making care transitions better. If you work in health care, you’re aware of the most important areas of focus.

Identifying complex patients and strengthening their support networks. Improving their continuity of care. Optimizing care plans and ensuring they’re used to guide treatment. Providing clear discharge instructions for patients and their family members.

Each of these objectives can have a strong positive impact on hospital readmission rates. Unfortunately, in practice, they can also seem vague.

For care teams, new technology provides practical ways of connecting and sharing information. The right platform or mobile app can streamline the entire at-home care delivery process.

Many patients who receive more responsive care at home are able to avoid serious health complications – and rehospitalization.

Think about the possibilities. An at-home patient with easy-to-use videoconferencing on her tablet or smartphone. A home care worker with real-time access to his patient’s care plan. Family members who can get health care support for their loved ones, precisely when they need it.

Digital technology can connect an entire circle of care, putting the power of communication at the fingertips of all of its members.

When it comes to people living with multiple chronic conditions, the value is obvious. Better care coordination means better care – and fewer readmissions.

Moving Forward

The number of patients with multiple chronic conditions affects us all. Unfortunately, readmission rates aren’t just costly in terms of dollars and cents – they have a real impact on the health of Canadians.

Tackling the costs associated with this epidemic will mean rethinking care coordination and person-centredness. With initiatives like Health Links, Ontario is on the right track. Moving forward, efficiency-enhancing technology will help the province achieve better outcomes.

Feature image courtesy of Masahiko OHKUBA

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