Missed Opportunities in Preventing Hospital Readmissions: Redesigning Post-Discharge Checkup Policies

• 成果类型: Article
• 署名作者: Liu, Xiang; Hu, Michael; Helm, Jonathan E.; Lavieri, Mariel S.; Skolarus, Ted A.
• 署名单位: University of Michigan System; University of Michigan; Massachusetts Institute of Technology (MIT); Arizona State University; Arizona State University-Tempe; University of Michigan System; University of Michigan
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/poms.12858
• 发表日期: 2018
• 页码: 2226-2250
• 关键词: PRIMARY-CARE; optimal inspection; colorectal-cancer; MODEL; discharge; prostate; surgery; interventions; replacement; BEHAVIOR

摘要

Hospital readmissions affect hundreds of thousands of patients every year, negatively impacting patients and placing a tremendous burden on the national healthcare system. Post-discharge checkup policies can reduce readmissions through early detection of health conditions, however, the methods behind designing effective checkup policies are poorly understood. Under current practice, up to 67% of readmitted patients return to the hospital before their first scheduled office visit. This work aims to develop effective checkup plans to monitor patients following hospital discharge, using a variety of checkup methods, including phone calls and office visits. We develop and analyze a new delay-time analysis model to identify the optimal type and timing of checkups to implement post-discharge monitoring plans. By analyzing the structure of optimal policies, we develop checkup schedules that can detect up to 43.7% more readmission-causing conditions experienced by readmission-bound patients. Further, we uncover simple rules of thumb that can help doctors design and improve monitoring plans even in the absence of advanced computer software or complex computations.