AUSTIN, TEX. – A multidisciplinary intervention, including implementation of a diagnostic scoring system and daily interdepartmental meetings to review cases, significantly decreased readmission rates for patients at a tertiary care center who were discharged with a diagnosis of pneumonia.
From November 2012 to January 2013 – a 3-month period after implementation of the quality improvement (QI) initiative – the all-cause readmission rates among 227 patients discharged with a diagnosis of pneumonia declined by 7.5 percentage points, compared with the all-cause readmission rates among 236 patients discharged during the same period in the prior year, before implementation of the initiative (from 20.7% to 13.2%), Dr. Hussein Hussein, a fellow at the University of Oklahoma Health Sciences Center, Oklahoma City, reported at the annual meeting of the American College of Chest Physicians.
A similar reduction was seen for pneumonia-related readmissions, which declined from 10.5% to 3% during the same period, said Dr. Hussein, who was with Yale New Haven Hospital, New Haven, Conn., at the time the research was conducted.
Courtesy NIH National Library of Medicine / Institute for Physical Education and Sport, University of Malta, Malta / Creative Commons License
All-cause readmission rates for 227 pneumonia patients discharged over 3 months declined by 7.5 percent.
Further, after implementation of the scoring system – a modified Clinical Pulmonary Infection Score (MCPIS) calculated based on patient temperature, white blood cell count, sputum cultures, oxygen requirements, and radiographic appearance, which was administered at admission and again at 32 hours – the accuracy of pneumonia diagnoses appeared to improve; the mean MCPIS scores among patients with a discharge diagnosis of pneumonia increased significantly after implementation (from 4 to 6); the proportion of patients considered unlikely to have pneumonia decreased from 42.6% to 3.6%; the proportion considered to probably have pneumonia decreased from 31.9% to 17.9%; and the number deemed likely to have pneumonia increased from 25.5% to 78.6%.
All of the changes were statistically significant, and the improved accuracy of diagnosis was likely a result of provider education that led to increased use of sputum cultures, Dr. Hussein noted.
Pneumonia is the second most common discharge diagnosis among Medicare beneficiaries, and nearly 20% of these patients are readmitted within 30 days at a cost exceeding $17 billion annually.
“This is why the Centers for Medicare & Medicaid Services is penalizing poor-performing hospitals with high rates of readmission,” he said.
The MCPIS was implemented in 2012 as a quality improvement tool. Based on the scores, patients were categorized as unlikely to have pneumonia (score of 3 or less), probably having pneumonia (score of 4-5), and likely to have pneumonia (score of 6 or greater). The daily meetings during which patients admitted with pneumonia were reviewed, involved participation of physicians from different medical divisions and representatives from nursing, social work, and continuing care.
The primary goal of these rounds was to ensure timely follow-up after discharge, Dr. Hussein explained, adding that if the diagnosis was felt to be incorrect, the case was discussed with the team that was caring for the patient.
To assess the effects of this intervention, he and his colleagues conducted a retrospective chart review of all patients discharged with a diagnosis of pneumonia during each of the two assessment periods.
“Our multidisciplinary intervention resulted in a significant decrease in readmission rates in patients discharged with a diagnosis of pneumonia, as well as improvement in the accuracy of diagnosis,” he said.
Dr. Hussein reported having no disclosures.