Patient Wellbeing Closely Linked to 30-Day Readmission Rates

WASHINGTON, D.C. -- There is a close link between the wellbeing of U.S. hospital patients and 30-day readmission rates, a Gallup study has found. Overnight hospital patients with high wellbeing are less than half as likely as those with low wellbeing to report having been readmitted for the same major health condition within the next 30 days. With this in mind, healthcare organizations can take practical steps to reduce readmissions.

The wellbeing-readmission relationship holds after taking into account the effects of age, gender, race/ethnicity, household income, education, marital status, existing chronic conditions, and health insurance status.

These results are based on 2,995 U.S. adults surveyed by web as part of the Gallup Panel, a probability-based panel of about 115,000 adults across all 50 states and the District of Columbia.

All respondents had stayed overnight in a hospital in the prior two years for heart or vascular problems (including coronary heart disease and heart attack), Type 1 or 2 diabetes, pneumonia, or a hip or knee condition. Most of these health conditions are among those evaluated as part of the Hospital Readmissions Reduction Program. The program and its associated penalties have been fully implemented since 2016.

As of fiscal year 2021, 82.7% of the 3,080 participating hospitals nationwide are now being assessed a penalty ranging from 0.01% to 3.0% (maximum) of their Medicare reimbursement revenue from the Centers for Medicare and Medicaid Services (CMS). This occurs when their 30-day readmission rates rise above a predetermined threshold based on the previous three years of readmissions data nationally, after adjusting for differences in patient mix. The magnitude of the penalty will vary depending on the readmission rate and typically ranges between $100,000 and $1 million annually for penalized hospitals.

Defining Wellbeing

Gallup defines wellbeing through five interrelated elements:

• Career wellbeing: You like what you do every day.
• Social wellbeing: You have meaningful friendships in your life.
• Financial wellbeing: You manage your money well.
• Physical wellbeing: You have energy to get things done.
• Community wellbeing: You like where you live.

The 10 question items used to measure the five elements in this analysis are part of the Gallup Wellbeing View Index, found on the online workplace survey and learning platform Gallup Access. Based on agreement levels with the 10 items, respondents were sorted into three categories:

• Those with optimum wellbeing have good or excellent wellbeing across all five elements. These patients are at the lowest risk for readmission within 30 days of discharge.
• Those with inconsistent wellbeing have average or below-average wellbeing among some of the elements. These patients are at moderate risk for readmission.
• Those with poor wellbeing have below-average or poor wellbeing across most or all elements. These patients are at the highest risk for readmission.

Adherence to Medications Is Best Among Those With Optimum Wellbeing

Of those respondents who had experienced an overnight stay, 73% were discharged with prescribed medicine. Three questions were administered to determine medication adherence.

For your most recent inpatient visit for any of these conditions…

• Do you ever forget to take your medicine?
• Were you careless at times about taking your medicine?
• Did you stop taking your medication after you were feeling better, but before you were supposed to stop?

Based on their responses, respondents were sorted into three categories:

• Full Adherence to Medication: reporting “no” to all three questions
• Partial Adherence to Medication: reporting “yes” to one of the questions
• Medication Adherence Failure: reporting “yes” to at least two of the three questions

Half of all respondents who were prescribed medication reported full adherence to their medication, while 20% suffered medication adherence failure.

Adherence to prescription medication is closely tied to readmission rates. Respondents reporting full adherence reported a 30-day readmission rate of 13.9%. Those reporting medication adherence failure, in turn, reported a significantly higher readmission rate of 22.1%.

As such, discharged patients suffering medication adherence failure have a 59% greater chance of readmission within 30 days than do their counterparts who adhere fully to their prescribed medication.

As with readmissions, the wellbeing of patients is significantly related to full medication adherence, underscoring its importance to this health issue. Treating medication adherence as an outcome in its own right, 56.1% of those patients with optimum wellbeing reported full medication adherence, compared with 38.5% among those with poor wellbeing.

What Leaders Can Be Doing Right Now to Reduce Readmissions

There are practical steps leaders of healthcare organizations can take to effect change around patient experiences and patient wellbeing to improve the odds of reducing 30-day readmission rates and increasing medication adherence rates.

• The wellbeing of patients should be measured and managed. Administering a short wellbeing survey to patients upon admission would require no more than about three minutes of their time, a minor addition to pre-admission processes. More than just confirmation of insurance, the resulting information about the patient could be entered into their case file and referenced by physicians and staff to help inform approaches ranging from financial assistance to post-discharge counseling to support groups. Caring for the whole person based on holistic wellbeing is a proven way to reduce readmissions for the current condition and future admissions for others.
• Hospital staff should give patients a full explanation of what their prescribed medications are meant to do -- and what they are not meant to do. Patients must get a complete account of how their medications work -- and what the likely health outcome will be if they fail to take all medications on schedule and as directed.
• Staff members should engage patients in a detailed discussion of their post-discharge care, particularly the elements that patients are directly responsible for managing. Whenever possible, hospital staff should include the patients’ support network in this discussion as well. Patients’ friends and family members -- the cornerstone of social wellbeing -- are not just custodians of the patients’ meds and diet; they are also partners in sustaining -- and perhaps overhauling -- the patients’ lifestyle. Motivation and attitude are proven aspects of medication adherence.
• Hospital staff should give patients materials and tools for achieving the highest possible wellbeing in a way that is customized to patients’ needs and most practical for them. Apps for smartphones may be appropriate for some patients, while printed background information may work better for others. In all cases, staff members should focus on patients’ conditions when giving them follow-up instructions. When patients feel that their post-care plan is built just for them, they will be more likely to embrace and follow it.
• Staff members should always verbalize treatment options, even when only one is the clearest choice. Patients are more likely to feel empowered when they are given multiple options to choose from, and they are more likely to adhere to their path after they do choose it. And gaining new insights and information about important topics is a key aspect of career wellbeing.

Ultimately, what healthcare leaders must fully understand is that doctors and staff can meaningfully and significantly influence major health outcomes such as medication adherence and 30-day readmission rates. Armed with this knowledge, they can act on these opportunities as vigorously and as directly as possible. Their actions can have substantial economic benefits for their hospital and its patients and ultimately on a broader national economy that is increasingly dependent on their performance and actions.

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Learn more about how the Gallup National Health and Well-Being Index works.