Involving family members in care may reduce hospital readmissions

Jan 28 2016

A new study finds that educating and involving family members in the care of a loved one who has memory loss may significantly reduce hospital readmissions.

When researchers at Henry Ford Hospital in Detroit evaluated the strategy in treating 489 patients in its congestive heart failure (CHF) unit, the results were impressive: the 30-day readmission rate dropped to 16 percent from 23 percent - a 30 percent decline.

Researchers theorize the decline could have been higher had they studied a larger pool of patients.

Mark Ketterer, Ph.D., a clinical health psychologist in the Department of Behavioral Health Services at Henry Ford and the study's lead author, called the strategy "astonishing simplistic but effective."

"Patients with memory loss often don't do well with taking their medication on time, renewing their medication and just coping in their day-to-day surroundings," says Dr. Ketterer. "If they're in a medical setting such as a nursing home, a nurse or other provider is able to monitor them and make sure they're doing these things reliably and consistently.

"Assigning a nurse to at-home patients is simply not feasible for manpower and cost reasons. We found that involving and educating the family about the forgetfulness we frequently see in patients and having them more involved in overseeing the care at home proved to be really successful in keeping patients from returning to the hospital."

Dr. Ketterer theorizes that the success of the family intervention strategy could be cost effective. Factoring in the cost of readmissions and the care associated with them, he says insurance companies could save nearly $180,000 a month for every 100 patients seen.

The study is published online in the American Journal of Accountable Care.

Memory loss, or cognitive impairment, affects an estimated 16 percent million Americans and is a well-known predictor of high readmission rates for patients with congestive heart failure, end stage renal disease and chronic obstructive pulmonary disease - conditions with the highest readmission rates. That number of people with memory loss is expected to increase substantially as the baby boom generation ages past 65.

In the Henry Ford study, Dr. Ketterer and his colleagues sought to evaluate the effectiveness of utilizing a health psychology service as part of the care team in the hospital's inpatient CHF unit in comparison to CHF patients treated in two other parts of the hospital without the service. The service included taking a patient's psychosocial history and baseline mental state and involving family members to "participate as collaborators in coping with this complication of the illness."

Researchers evaluated 489 patients, or 17 percent, of total admissions to the Cardiology Teaching unit in 2014. Results:

• Average 30-day readmission rate on the CHF unit was 16 percent.

• Average 30-day readmission rate on a cardiac floor unit was 21.5 percent.

• Average 30-day readmission rate on other patient units was 22.8 percent.

Nationally, the average 30-day readmision rate is 23 percent.