Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions With Connection to Primary Care Within 7 Days of Hospital Discharge

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Abstract
Hospital readmissions are costly indicators of the quality of patient care.1,2 In 2012, 7% of the US population had a hospital stay, for a total cost of $381 billion,3 and an estimated 1 in 12 adults is readmitted within 30 days, adding $16 billion to health care costs annually.4 To address costs and improve care quality, the Patient Protection and Affordable Care Act established the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program. Launched in October 2012, this program ties payments for all Medicare admissions to hospitals’ readmission rates, creating motivation for hospitals to reduce avoidable readmissions.2 An estimated one-quarter of all 30-day hospital readmissions are preventable, and many of these can be traced to inadequate postdischarge follow-up.5 Timely postdischarge follow-up with a primary care provider (ie, a physician, nurse practitioner, clinical nurse specialist, or physician assistant as allowed under state law) can improve care transitions and reduce readmission risk through medication reconciliation, discharge plan review, and patient education.6,7

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