Small, rural, and community-based hospitals face many of the same concerns about readmissions as large ones. James Baumgartner, MD, chief hospitalist at Essentia Health-St. Joseph’s Medical Center in Brainerd, Minn., population 13,517, was asked if he sees the readmissions issue playing out differently in rural settings.
“I don’t think so, and I’ve practiced in bigger cities,” he says. “For the past two years, we’ve had a team-based approach here, with a multidisciplinary committee meeting monthly to work on making transitions of care better.”
The recent adoption of joint rounding by hospitalists and nurses also makes a difference, he says. To ensure that patients can get post-discharge medical appointments when they need them, Dr. Baumgartner’s group approached local PCPs within the same health system.
“They responded by reserving at least one open slot at the start of every day for seeing our recently discharged patients,” he says.
Kristi Howell, RN, director of quality initiatives at Richland Memorial Hospital, a 65-bed acute care facility in Olney, Ill., population 8,631, says the trend in smaller and rural hospitals is moving toward more personalized patient care and the use of one-on-one transitional care coordinators.
“We have the advantage of being closer to our patients and providing a more personalized discharge plan than may be possible at a larger facility,” she says. Nevertheless, Howell and her colleagues are “deeply concerned about readmissions.”
“Physicians in this area experience difficulty with readmissions due to our rural patients’ lack of access to larger facilities and medical specialties,” she says. “Noncompliance is another problem, mostly due to lack of health literacy and financial resources. Of course, it is well known that the shortage of primary care doctors is a contributor to poorer health outcomes for rural residents.”
Randy Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service at 47-bed Riverside Tappahannock Hospital in Tappahannock, Va., population 2,393, says he’s “tried all sorts of things, with little impact on readmissions,” although his five-member groups’ readmission rate is “actually low compared with the national average.”
“We make appointments for the first week after discharge,” he says. “We’re small enough that we can call the PCP. We know them. We all belong to the same medical group.”
Dr. Ferrance covers shifts in the ED on occasion. He says some patients in the community prefer to get their medical care at the ED. “And in the ED, if they don’t look well, they get admitted,” he says.
Larry Beresford is a freelance writer in Alameda, Calif.