Can Oncology Readmissions Be Reduced? The Cleveland Clinic Experience

6573 Background: Reducing 30-day readmissions is a national policy priority. Readmissions in medical oncology patients have not been extensively evaluated, and may not be reasonably preventable. We examined the impact of interventions focused on reducing oncology readmissions in the palliative medicine (PM) and general medical oncology (GMO) units. Methods: Baseline rates of readmissions were gathered in the period January 2013 to March 2014. Interventions were initiated in the period leading to April 1, 2014 including: (i) provider education, (ii) within 48 hours post-discharge nursing phone calls, and (iii) within-5-day post-discharge provider follow-up appointments. Calling nurses performed symptom management, education and encouraged prescription/appointment compliance. Results: There were a total of 3,729 combined admissions and 1,003 readmissions in the baseline period, for a readmission rate of 26% for PM and 27% for GMO units. In the 8-month intervention period (May-Dec 2014), there were 1,694 admissions, and 396 readmissions. Callbacks and 5-day appointments were monitored with a mean compliance of 77% and 70%, respectively, improving during the study period. PM readmission rates declined by 5% to 21% (p = 0.01, relative risk reduction 19%). GMO readmissions also decreased by 3% to 24% (p = 0.02, relative risk reduction 11%). The mean total cost of one readmission was $18,365, suggesting an annual potential cost savings of $2.91 million with the observed reduction in readmissions. Conclusions: Readmission reductions in both units were achieved through better systematic transitions to outpatient care, including follow-up calls and early provider visits; thereby leading to a reduction in utilization of inpatient resources. These data suggest that efforts focused on improving outpatient care transition are effective in reducing oncology readmissions. This is particularly relevant in the transition towards novel bundled payment models in oncology. The observed feasibility and patient/provider acceptance of these interventions suggests sustainability, and will be validated over longer time periods.