One of the continuing problems with the quality of Substance Abuse treatment services in rural states has been the growing concerns over the high numbers of patients failing to complete residential treatment. Many times these same patients turn around only to be re-admitted for care within 90 days for the same diagnosis.
Even in cases where patients are discharged from services as “treatment complete”, they are often left with fragmented follow-up of care: these problems include infrequent referrals to After Care services, linkages to AA Sponsors, basic networking to jobs and sober living arrangements and poor communications with treatment program case managers.
According to the Robert Wood Johnson Foundation, “many of these re-admissions are caused by inadequate discharge planning, poor care coordination between facilities and clinicians and the lack of longitudinal community based care.” There’s little question that the high numbers of patients leaving early against medical advice from publicly funded Residential addictions treatment program system plays into the problem of expensive patient re-admissions.
One major flaw in many rural states data collection systems is continuing lack of accounting for the numbers of patients now leaving treatment early only to be re-admitted for addictions services somewhere else in the public delivery system. This current pattern of revolving door in expenditures of public monies serving the same people repeatedly should be considered for replacement by a performance based contracting process. However, implementation of a performance based contracting process would require treatment programs to document successful, patient outcomes linked to national standards of quality improvement.
What is interesting is that Behavioral Health research data suggests the best timing for aftercare coordination should be started at the time of Admission and not before the patient is fully ready for discharge. problems at this time occur since patients and their families often do not understand their roles in overcoming addictions. Studies have clearly shown, “re-admission rates can be reduced through coordinated discharge planning, education of patients and families about how to handle their chronic medical conditions, and by close follow-up by a nurse after the patient is discharged from treatment.”
Programs simply do not have a clear perspective of the quality control problems leading to their patient re-admissions.
This research is part of a Robert Wood Foundation Report on U.S. Hospital Admissions where they found that “Information about a patient does not always travel with the individual back to their home community, resulting in tenuous accountability scattered among community physicians, referral agencies and families.”
It is interesting to note the Affordable Care Act, directs the Center for Medicaid / Medicare Services (CMS) to develop Community based Care Transition Programs (CCTP) and provides funding to test Models for improving care to high risk patients.
Klees BS, Wolfe CJ and Curtis CA. Brief Summaries of Medicare and Medicaid: Title XIX of the Social Security Act as of November 1,2010. Baltimore, MD. Office of the Actuary at the Centers for Medicare & Medicaid Service, 2010, www.cms.pov/MedicareProQramRatesStats/downloads/ MedicareMedicoidSummories2010.pdf
Jencks SF, Williams MVand Coleman EA. “Re-hospitalizations among Patients in the Medicare Fee-For-Service Program.” New England Journal of Medicine, 360(14): 1418-1428, 2009.
Carlos T. Jackson, Troy K. Trygstad, Darren A. DeWalt and C. Annette DuBard.” Transitional Care Cut
Hospital Readmissions for North Carolina Medicaid Patients with Complex diagnoses.
Chronic Conditions”. Health Affairs, 32, no.8 (2013) 1407-1415.
Addictions Consulting group
The Addictions Consulting Group (ACG) is a premier national consulting firm specializing in helping people, teams, and organizations achieve maximum effectiveness. We provide an expert staff of senior practitioners, offering our clients exceptional experience, diversified insight, and a range of services. ACG Groups Team offers assistance with CARF accreditation policies and systems, CARF Planning manuals, strategic planning, coaching, training, and quality improvement, outcome evaluation reports and Electronic Health Records software.
In today’s climate of scarce resources for behavioral health programs, only those programs that can credibly demonstrate their cost-effectiveness and outcome reliability will garner the funding necessary to sustain and expand their efforts.
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