![]() ![]() ![]() Other issues at discharge include lack of communication with the primary care physician (PCP) at discharge, a decreasing number of available PCPs ( Williams, 2013), inadequate or nonexistent medication reconciliation ( Boling, 2009), incomplete or inaccurate information transfer to the next provider ( Boling, 2009 Williams, 2013), and patient non-compliance with prescribed medications ( Boling, 2009). Recent studies have found that lack of primary care follow-up within seven days of discharge increases risk of 30-day readmission tenfold ( Hernandez et al., 2010 Takahashi et al., 2013). In fact, the Institute of Medicine has explicitly identified transitional care as a high-priority area for performance measurement ( Institute of Medicine Staff, 2006). Poor transitions that lack care continuity have been found to lead to adverse outcomes and greater risk of readmission, especially for older adults ( Arbaje et al., 2008 Coleman, Parry, Chalmers, & Min, 2006 Jencks et al., 2009). This amount accounts for 17–24% of overall Medicare hospital expenditures, ( Jencks et al., 2009), which is especially concerning considering that 75% of readmissions are thought to be avoidable ( Hansen et al., 2011). It appears that American hospitals are not performing as well as desired: it is estimated that 20–25% of Medicare beneficiaries are readmitted within 30 days of hospital discharge and that these readmissions cost $26 billion annually ( Allaudeen, Schnipper, Oray, Wachter, & Vidyarthi, 2011 Centers for Medicare and Medicaid Services, 2012 Graham, Leff, & Arbaje, 2013 Hansen et al., 2011 Hernandez et al., 2010 Jencks, Williams, & Coleman, 2009 Voss et al., 2011). Thirty-day readmission rates are an accepted marker of discharge success and a reflection of quality of care ( Allaudeen, Vidyarthi, Maselli, & Auerbach, 2011 Bjorvatn, 2013 Jha, Orav, & Epstein, 2009 Vashi et al., 2013). High rates of readmissions among American hospitals have an enormous impact on quality of life and costs of care of the American health care system ( Bjorvatn, 2013 Coleman, Parry, Chalmers, & Min, 2006 Hansen, Young, Hinami, Leung, & Williams, 2011 Hernandez et al., 2010 Williams, 2013). ![]()
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