BINGHAMTON, NY – When a Medicare patient heads home from a hospital stay, the last thing that patient wants is to be readmitted. It’s not a healthy strategy for recovery, and it is costing the healthcare industry and government-run Medicare, billions of dollars each year. In addition, with hospitals being penalized under the Affordable Care Act for readmission of Medicare patients within 30 days of discharge, the costly outlays are expected to get higher.
That is why researchers from Binghamton University’s College of Community and Public Affairs and SUNY Upstate Medical University are teaming up to determine how this revolving door of readmissions can be stopped. Their goal is to come up with community-based alternatives aimed at keeping the discharged patient healthy and out of the hospital. This particular project focuses on the role social workers can play in the lives of recently released patients.
Laura Bronstein, professor and chair of Binghamton University’s Department of Social Work, is also the director of the University’s Institute for Intergenerational Studies. She created this interdisciplinary training program so social workers and medical professionals could better understand the challenges each group faces in trying to improve patient health in and out of the hospital.
Her group’s two-year study, now in its final year, was designed to collect data from approximately 100 patients at high risk for hospital readmission but able to live independently. The social work students were assigned to follow up with patients released from United Health Services’ Wilson Medical Center in Johnson City.
“The students start by making phone calls to check on the patients and then they actually arrange to visit the recently released patient,” said Bronstein. She adds, “The social-work students find out how the patient feels and whether they are taking their medicine or experiencing any side effects from the medicine. There is even an assessment of the individual’s home environment to determine if there are risks of the patient falling or straining themselves too much to accomplish a simple task like opening a garage door.”
Anything that makes the former patient’s life more difficult increases the risk of returning to the hospital. “In addition to our students tracking and possibly improving the patient’s home environment, a big piece of making this work is simply making sure people follow up with their primary care physician,” said Bronstein.
The project is continuing, but already there are signs that the social work intervention is working. The participants in the experimental group experienced only a 7 percent readmission rate. Patients discharged from Wilson Medical Center during the same period and meeting the same criteria, but who are were in the control group experienced a 15 percent return rate. At some hospitals nationwide, the average readmission rate can be as high as 30 percent.
Dr. Shawn Berkowitz, medical director of the study, director of geriatrics at UHS and a clinical assistant professor at SUNY Upstate Medical University, says preliminary analysis of the initial participants is promising.
“If other hospitals can duplicate this model, they would save hundreds of thousands, if not millions, of dollars every year,” he said. “A social worker can create savings equal to his own salary and benefits just by preventing seven readmissions a year, and the patient’s quality of life is improved significantly in the process.”
You can read more about this project in Binghamton University Magazine at www.binghamton.edu/magazine.
