Improving care transitions and reducing readmissions
The SCAL Readmissions Reduction Steering Committee desperately needs ongoing analytical support for data-driven decision making on the provision of care transition services and interventions for the 150K annual discharges from KFH hospitals. Since 30-day readmission rates affect Medicare 5-star ratings and financial penalties, reducing avoidable readmission without causing patient harm is high priority for the organization. Care transition services are often complex and multi-component in nature and are constantly evolving. Evaluation of impact requires significant data curation efforts and advanced statistical methods to assess individual, additive or synergistic effects across the multiple intervention components. Different study designs and analytical methods will be used depending on the specific questions to maximize rigor, e.g. retrospective cohort, econometric approaches. Previous analyses have informed critical operational decisions.