Novant Dissolves Disparity in Pneumonia Readmissions

A North Carolina health system finds racial disparity in pneumonia patient readmission rates, identifies causes of problem, launches interventions, and eliminates gap.

In less than two years, Novant Health eliminated disproportionately higher hospital readmission rates for African-American pneumonia patients, who had readmission rates 4% higher than Caucasian patients.

The impetus for the initiative came in April 2016, when Novant President and CEO Carl Armato signed the American Hospital Association's #123for Equity Campaign pledge.

"That's really what jumpstarted this project," says Regina Fambrough, program manager for diversity and inclusion.

After signing the equity pledge, one of the first steps taken to address diversity gaps at Novant was an examination of readmissions data at the health system, which features 11 acute care hospitals.

In the analysis, readmissions were segmented by race, ethnicity, language, gender, age, and payer source.

"What we found was there was a disparity, and it could continue to get worse. The readmission rates for African-American pneumonia patients were 4% higher than for the Caucasian population," says Tanya Blackmon, executive vice president and chief diversity and inclusion officer.

Novant closed the gap last year:

• In the third quarter of 2017, the readmission rate disparity was cut in half to 2%
   
• In the fourth quarter of 2017, readmission rates for pneumonia showed no disparity

Finding Disparity Causes

In May 2016, the Winston-Salem-based health system formed the Pneumonia Readmissions Team to study the source of the disparity and to launch interventions aimed at closing the readmissions gap.

The Pneumonia Readmissions Team, which includes Blackmon and Fambrough, is an interdisciplinary panel that meets monthly.

The panel includes a hospitalist physician, the health system's transcultural health manager, the director of case management, a care coordination representative, nursing, pharmacy, a pulmonary navigator, and a data and analytics representative.

The team's data analysis, which included 100 comprehensive medical record reviews, revealed two primary causes of the African-American pneumonia readmissions gap:

• For patients who were readmitted, there was often fewer case management assessments compared to other patients and few people to provide home care.
   
• Care coordinator calls to African-American pneumonia patients were problematic. For example, when the transcultural health manager called these patients, Blackmon said she found they didn't realize the calls were from a care coordinator.

Novant has launched several initiatives to close the African-American pneumonia readmissions gap, such as:

• Collaboration between case management and electronic health record report writers to redesign patient lists to encourage assessments at discharge, which has helped boost case management assessments 22%
   
• Warm handoff: Discharge nurses tell the patient that the care coordination team will be following up by phone and to expect a call
   
• Pulmonary navigators, who were hired to work closely with pneumonia and COPD patients, organize timely patient referrals to the care coordination team for follow-up postdischarge
   
• In 2017, Novant launched new scheduling for patient follow-up visits, with follow-up visits set before hospital discharge. The new scheduling drove a 12% improvement in African-American pneumonia patients receiving a follow-up visit within seven days of discharge, and there was a 25% increase in patients keeping appointments.

Blackmon says Novant expects to have return on investment numbers for the initiative later this year, but says the effort is generating cost savings.

"We are all in agreement that there are avoidable costs here—when you are readmitting a patient, you may not get reimbursed for the readmission," she says.

In February, the Centers for Medicare & Medicaid Services recognized Novant's pneumonia disparity work with the inaugural Health Equity Award. Kaiser Permanente also received the award, which was presented in Baltimore.