Skip to main content
  • Other Publications
  • Subscribe
  • Contact Us
Advertisement
JCORE Reference
this is the JCORE Reference site slogan
  • Home
  • Most Read
  • About Us
    • About Us
    • Editorial Board
  • More
    • Advertising
    • Alerts
    • Feedback
    • Folders
    • Help
  • Patients
  • Reference Site Links
    • View Regions
  • Archive

The Revolving Hospital Door

Alan M. Jette
DOI: 10.2522/ptj.2016.96.12.1858 Published 1 December 2016
Alan M. Jette
A.M. Jette, PT, PhD, FAPTA, is editor in chief of PTJ.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

While I was writing this editorial on hospital readmissions, my 90-year-old mother was admitted to her local community hospital for a severe circulation problem and leg sores. After 10 days of hospital-induced immobility and a series of inconclusive diagnostic tests, she was discharged home to her Buffalo, NY, apartment where she lives alone. Her discharge plan consisted of a request that she contact her vascular specialist to schedule weekly follow-up visits for management of her leg sores, and advice from a hospital physical therapist to walk more to reverse her severe deconditioning.

Luckily for my mother, she has a son and family and friends who live close by to provide essential support services—and another son who happens to know many physical therapists in the area who could be engaged to provide her with the postacute care she needs, both to return to her pre-hospital level of function and to reduce the risk of a fall that could land her back in the hospital. But my mother's experience is a clear example of the all-too-common “silo of care” that exists when the patient leaves the acute care hospital: there is little or no integration between acute care and the transition to postacute care; and short-term hospital readmission, or worse, frequently results.

Preventable readmission of patients within a month of acute care hospital discharge is considered one of the nation's major drivers of high medical costs, accounting for an estimated $17 billion annually in Medicare spending alone.1 And returning to the hospital soon after discharge not only is costly and a sign of poor care, but can be deeply troubling for patients who think they are on the road to recovery at discharge only to discover that they need help to achieve a safe and successful transition back home.

The almost 20% readmission rate of Medicare patients led the Centers for Medicare and Medicaid Services (CMS) to implement policies that limit reimbursement for 30-day unplanned readmissions and thus place hospitals with high readmission rates at financial risk.1 Partly in response to this CMS initiative, reducing the 30-day hospital readmission rate has become a major quality improvement priority for hospitals.2 But as my mother's case illustrates, much more needs to be done to move beyond the “silo of care” model to provide the level of coordinated and integrated care that people need.

My mother's recent experience highlights some of the reasons for the high rates of 30-day hospital readmissions in the United States and the important role that physical therapists and other rehabilitation professionals can play in improving hospital discharge planning and the transition to postacute care. The reasons for 30-day hospital readmission are complex and multifaceted. According to existing evidence, key risk factors include3,4:

  • Medical complexity

  • Age

  • Comorbidities

  • Access to community care

  • Hospital length of stay

  • Available social support

  • Patient's functional limitations

In a nationally representative cohort of almost 8,000 community-living older adults, researchers showed that the adjusted risk of 30-day hospital readmission progressively increased as the degree of functional limitation increased, from 13.5% of older adults who have no functional limitation to 18.2% of older adults who are dependent in 3 or more activities of daily living (ADLs).5 Rehabilitation professionals are uniquely qualified not only to assess a patient's functional limitations during a hospital stay, but to develop treatment goals beyond the hospital setting and facilitate referrals to postacute care providers when needed.

Currently, physical therapists in the United States are not routinely included in care transition efforts beyond recommendations of discharge location,3 despite the growing evidence that they can play an important role in reducing rates of 30-day hospital readmission.6–9 Care transitions are an increasingly important part of policy initiatives such as the CMS bundling payment programs, and short-term hospital readmission is a common quality indicator within these initiatives. Physical therapists need to advocate for their role in reducing short-term hospital readmission through improvements in post–hospital discharge management of patient function.

What steps could physical therapists take to assume a stronger role in the treatment of hospitalized persons within care transition teams? In a thoughtful perspective on the role of physical therapists in reducing hospital readmissions, Falvey and colleagues3 cite 3 important roles that physical therapists could play:

  • Educate their clinical colleagues and hospital administrators on the important role that rehabilitation professionals can play in discharge planning, drawing on the growing evidence of their value and impact in this area.

  • Become intimately involved in the design and implementation of research within and across hospitals and medical centers to evaluate and then disseminate the impact of different care transition models aimed at reducing 30-day hospital readmission that involve rehabilitation during and after the hospital stay. Kadivar and colleagues' evaluation of the positive role of physical therapist involvement in hospital discharge planning teams published in the November issue of PTJ is an excellent example of this type of research.6

  • Work with their institutions to adopt and utilize assessment tools that enhance communication across professions regarding the functional deficits and discharge needs of patients as they transition from acute to postacute care. Given the short lengths of stay in acute care hospitals and the focus on assessing patients to make discharge recommendations and manage postdischarge function, measurement tools that enhance the accuracy of discharge recommendations at an early stage could prove to be indispensable. Assessment tools (full disclosure—tools such as the one developed by my colleagues and me10) are available that can be used not only within the hospital setting but across postacute care venues as well.

Hospitalizations are stressful for patients and families and can be dangerous to a patient's long-term health. Although some hospital readmissions cannot and should not be prevented, acute care hospitals have an obligation to engage in activities that can lower the current high rate of short-term readmissions. Rehabilitation professionals can and should play an important role within interdisciplinary teams in improving the hospital discharge planning process and in coordinating with postacute care and primary care providers to reduce the alarming rates of short-term hospital readmission.

Special Message from the Editor in Chief

As PTJ enters into its co-publishing partnership with Oxford University Press, Dr. Jette takes the opportunity to recognize the exceptional contributions made by journal staff: Steve Brooks, ELS, associate staff editor and consummate manuscript copyeditor for 3 decades; Karen Darley, editorial tracking manager and PTJ nerve central; Steven Glaros, MA, assistant managing editor and digital editor, who kept the trains running on time; Natacha Leonard, editorial assistant and eagle-eyed proofreader; Michele Tillson, permissions expert and editorial assistant; and Jan Reynolds, managing editor, who has led the journal through a number of big changes. These individuals have been critical to PTJ's growth, and, on behalf of Editorial Boards past and present, we thank them.

  • © 2016 American Physical Therapy Association

References

  1. ↵
    1. Berenson RA,
    2. Paulus RA,
    3. Kalman NS
    . Medicare's readmissions reduction program—a positive alternative. NEJM. 2012;366:1364–1366.
    OpenUrlCrossRefPubMedWeb of Science
  2. ↵
    1. Gerhardt G,
    2. Yemane A,
    3. Hickman P,
    4. et al
    . Data shows reduction in Medicare hospital readmission rates during 2012. Medicare Medicaid Res Rev. 2013;3:E1–E11. Available at: https://www.cms.gov/mmrr/downloads/mmrr2013_003_02_b01.pdf. Accessed October 31, 2016.
    OpenUrlCrossRef
  3. ↵
    1. Falvey JR,
    2. Burke RE,
    3. Malone D,
    4. et al
    . Role of physical therapists in reducing hospital readmissions: optimizing outcomes for older adults during care transitions from hospital to community. Phys Ther. 2016;96:1125–1134.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Gohil SK,
    2. Datta R,
    3. Cao C,
    4. et al
    . Impact of hospital population case-mix, including poverty, on hospital all-cause and infection-related 30-day readmission rates. Clin Infect Dis. 2015;31:1235–1243.
    OpenUrl
  5. ↵
    1. Greysen SR,
    2. Stijacic Cenzer I,
    3. Auerbach AD,
    4. Covinsky KE
    . Functional impairment and hospital readmission in Medicare seniors. JAMA Intern Med. 2015;175:559–565.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Kadivar Z,
    2. English A,
    3. Marx BD
    . Understanding the relationship between physical therapist participation in interdisciplinary rounds and hospital readmission rates: preliminary study. Phys Ther. 2016;96:1705–1713.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Smith BA,
    2. Fields CJ,
    3. Fernandez N
    . Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Phys Ther. 2010;90:693–703.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Kim SJ,
    2. Lee JH,
    3. Han B,
    4. et al
    . Effects of hospital-based physical therapy on hospital discharge outcomes among hospitalized older adults with community-acquired pneumonia and declining physical function. Aging Dis. 2015;6:174–179.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Green UR,
    2. Dearmon V,
    3. Taggart H
    . Improving transition of care for veterans after total joint replacement. Orthop Nurs. 2015;34:79–86.
    OpenUrlCrossRefPubMed
  10. ↵
    1. Jette DU,
    2. Stilphen M,
    3. Ranganathan VK,
    4. et al
    . AM-PAC “6-Clicks” functional assessment scores predict acute care hospital discharge destination. Phys Ther. 2014;94:1252–1261.
    OpenUrlAbstract/FREE Full Text
View Abstract
PreviousNext
Back to top
Vol 96 Issue 12 Table of Contents
Physical Therapy: 96 (12)

Issue highlights

  • Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes
  • Physical Therapist–Led Ambulatory Rehabilitation for Patients Receiving CentriMag Short-Term Ventricular Assist Device Support: Retrospective Case Series
  • Education Research in Physical Therapy: Visions of the Possible
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation
  • Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
  • Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation
  • Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis
  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Measurement Properties of Instruments for Measuring of Lymphedema: Systematic Review
  • myMoves Program: Feasibility and Acceptability Study of a Remotely Delivered Self-Management Program for Increasing Physical Activity Among Adults With Acquired Brain Injury Living in the Community
  • Application of Intervention Mapping to the Development of a Complex Physical Therapist Intervention
Email

Thank you for your interest in spreading the word on JCORE Reference.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Revolving Hospital Door
(Your Name) has sent you a message from JCORE Reference
(Your Name) thought you would like to see the JCORE Reference web site.
Print
The Revolving Hospital Door
Alan M. Jette
Physical Therapy Dec 2016, 96 (12) 1858-1859; DOI: 10.2522/ptj.2016.96.12.1858

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Save to my folders

Share
The Revolving Hospital Door
Alan M. Jette
Physical Therapy Dec 2016, 96 (12) 1858-1859; DOI: 10.2522/ptj.2016.96.12.1858
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Article
    • Special Message from the Editor in Chief
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Meeting the Challenge of the High-Need, High-Cost Population
  • Partnering With Oxford University Press
Show more Editorials

Subjects

  • Intervention
    • Coordination, Communication, and Documentation
  • Health Policy & Administration
    • Health Care System
  • Physical Therapist Practice
    • Professional Issues
  • Editorials
    • All Editorials
    • Alan Jette
  • Acute Care

Footer Menu 1

  • menu 1 item 1
  • menu 1 item 2
  • menu 1 item 3
  • menu 1 item 4

Footer Menu 2

  • menu 2 item 1
  • menu 2 item 2
  • menu 2 item 3
  • menu 2 item 4

Footer Menu 3

  • menu 3 item 1
  • menu 3 item 2
  • menu 3 item 3
  • menu 3 item 4

Footer Menu 4

  • menu 4 item 1
  • menu 4 item 2
  • menu 4 item 3
  • menu 4 item 4
footer second
footer first
Copyright © 2013 The HighWire JCore Reference Site | Print ISSN: 0123-4567 | Online ISSN: 1123-4567
advertisement bottom
Advertisement Top