Early Primary Care Provider Follow-Up for High Readmission Risk Native Hawaiian Health Project Patients at the Queen's Meidcal Center
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2018-05
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University of Hawaii at Manoa
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Hospitals within the United States are burdened by the steep costs associated with preventable readmissions. With growing concern over high readmission rates among Native Hawaiians, The Queen’s Medical Center implemented the Native Hawaiian Health (NHH) Project. The author of the Doctor of Nursing Practice project partnered with the NHH Project to develop, implement, and evaluate an evidence-based readmission reduction practice change. The Iowa Model was selected as the conceptual framework to guide the project. Following an analysis of NHH Project data, it was revealed that primary care provider (PCP) follow-up for “high readmission risk” patients could be significantly improved. Following a literature review on PCP follow-up timeliness, key recommendations were synthesized and informed the development of the practice change innovation—an early (2 business days) PCP follow-up visit guideline. To operationalize the guideline, an interdisciplinary workflow process was implemented. The workflow process utilized the NHH Project APRN’s risk assessment reports to substantiate early PCP follow-up for high readmission risk patients at the Queen Emma Clinic. To evaluate project outcomes, a “process” and “impact” evaluation was conducted. All “process” measures improved following implementation, demonstrating guideline adherence and workflow functionality. A post-pilot focus group identified that staff viewed the project favorably; select staff unawareness of the practice change was perceived as a barrier. In regard to “impact” measures, while the overall readmission rate remained unchanged, the readmission rate increased for patients who did not receive PCP follow-up, and decreased for patients who did receive PCP follow-up. These findings suggest the practice change may have prevented an increase in overall readmission rate. An incidental finding was the high rates of homelessness, substance use, and/or mental illness among patients who did not receive PCP follow-up. This trend identified the need to explore innovative approaches to health maintenance for these vulnerable populations. As a quality improvement initiative, the project had several limitations. First, the practice change was implemented in a fluid environment without controlled variables and conditions. Second, the project’s marginal sample size limited the ability to draw reliable inferences from evaluation data. Despite these limitations, practice change sustainment and expansion should be considered.
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Readmission, PCP
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Hawaii
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