Case study: Reducing readmission rates via interactive patient screenings

Like all hospitals, McLaren Port Huron in Michigan is constantly searching for ways to reduce our readmission rates. No small task, considering that one of every six discharged patients in the United States is readmitted in fewer than 30 days, and a third of those within only seven days of discharge, according to a March 2019 article from Forbes.

As McLaren’s clinical outcomes coordinator, I’ve done a lot of research over the years to discover the best way to do this. And everything I’ve read points to one thing – readmissions can be largely attributed to what happens after the patient leaves our care. Even with a team of the most dedicated physicians, nurses, and other clinicians, we can only do so much to address factors such as healthy eating, medication adherence and the availability of transportation to follow-up appointments after the patient is discharged. And it’s precisely these factors – all impacted by larger social determinants of health (SDOH) to one degree or another – that influence whether (and how soon) our inpatients become readmission statistics.

In fact, a report from the Yale Global Health Leadership Institute notes that actual medical care only makes up 20% of what determines a patient’s health; the rest is determined by genetics (20%) and the majority by social, environmental and behavioral factors (60%).