How to Reduce 30-Day Hospital Readmission Rates
Hospital readmission rates are an important quality metric in the healthcare industry. Since one in five Medicare patients are readmitted to the hospital within 30 days of discharge, it’s a cause of major concern for practitioners and providers. And justifiably so: The Centers for Medicare and Medicaid Services withhold reimbursements to hospitals with excessively high readmission rates. The cost to hospitals was about $108 million more in 2017 than in the previous year for readmissions alone. As the industry seeks to better understand this issue and reduce the rates of readmission, the connection to lack of sleep and patients returning to the hospital within 30 days is significant.
In a retrospective review of patients discharged over a 24-month period to a Department of Defense hospital, medical records, presence of obstructive sleep apnea (OSA), and comorbid diseases were studied to determine whether readmission occurred within 30 days of discharge. Of 22,261 unique patients discharged, 1,899 (8.5%) were readmitted in this timeframe. Patients with OSA had a readmission rate of 11.4% versus 7.6% for patients without OSA, proving that OSA is an independent risk factor for hospital readmission following 30 days of discharge.
Continuous Positive Airway Pressure (CPAP) therapy is effective for those with OSA, but appears to be underutilized as a treatment. Only about 38% of the patients in each group (48 readmitted and 47 non-readmitted) reported using outpatient CPAP therapy. Far fewer patients met criteria for the minimum standard of CPAP adherence defined as a minimum of four hours a night on 70% of nights for a 30-day period.
In a recent study published in the Journal of Clinical Sleep Medicine, objective CPAP data (as defined by the minimum criteria) was analyzed in 345 patients with OSA from January 1, 2007 to December 31, 2015. Results showed that patients who don’t adhere to CPAP therapy are three times more likely to be readmitted to the hospital within 30 days for any cause, and twice as likely to be readmitted for cardiovascular reasons. The leading causes for readmission in these patients were atrial fibrillation, myocardial ischemia, and congestive heart failure - all of which are connected to untreated sleep apnea.
Non-adherence to this treatment has also been associated with increased chronic obstructive disease (COPD) exacerbations, worsened insulin resistance, psychiatric illnesses, and lower urinary tract symptoms, among other things. Because of the negative cascade that results from lack of proper treatment for OSA, the rates of hospital readmission for high risk groups continue to exceed normal rates.
In order to reduce rates of 30-day readmission and effectively cut financial penalties to hospitals, we need accurate diagnosis and treatment of sleep apnea. In another study published in the Journal of Clinical Sleep Medicine, 104 cardiac patients admitted into a hospital were monitored on portable CPAP systems. Of these patients, 78% had sleep disordered breathing (SDB), 80% had OSA, and 20% had predominantly central sleep apnea. The data showed that hospital readmission 30 days after discharge were significantly lower in patients with cardiac disease and SDB who adhered to CPAP treatment than those who did not. None of the newly treated sleep apnea patients who were CPAP compliant were readmitted versus 30% of the untreated, noncompliant patients who were.
Since the data has proven that successful treatment of sleep apnea has been shown to reduce rates of hospital readmission, it’s important that providers and practitioners put their patients on a path of better sleep. BetterNight offers a high-quality, patient-centric approach to comprehensive sleep solutions, helping to cut costs while improving patient outcomes. Research shows that patients will stick with a treatment plan that is customized to their needs, and we achieve 99% customer satisfaction. With BetterNight, patient adherence to sleep apnea treatment is 67% versus 33% of traditional sleep management solutions. Patients can receive diagnosis and treatment within as little as 10 days and benefit from ongoing coaching and support to ensure adherence, which is the key to cutting 30-day hospital readmission rates.