AHRQ Initiative to Assess Role of Primary Care in Preventing Readmissions

The Agency for Healthcare Research and Quality (AHRQ) has conducted numerous initiatives in hopes of preventing hospital readmissions, but a recently proposed project would examine ways to achieve this goal with a focus on the primary care setting.

In its request for the project’s approval by the Office of Management and Budget, AHRQ outlined the goals of the research project and invited public comments on the proposal. The comment period will be open until April 14.

Hospital readmissions, according to the proposal, are a key indicator of healthcare quality and present increased opportunities for medical errors that can endanger patients. As such, reducing the number of preventable hospital readmissions has been a prominent goal of agencies like CMS, which implemented the Hospital Readmissions Reduction Program in 2012 to incentivize hospitals to lower their readmission rates.

AHRQ has conducted a number of efforts to develop evidence-based guidelines “largely focused on enhancing practices occurring within the hospital setting,” such as Project BOOST (Better Outcomes by Optimizing Safe Transitions). Although primary care settings have often been mentioned in these projects, literature focusing specifically on the role of primary care in preventing readmissions has been scarce.

To remedy this gap in guidance, AHRQ has proposed The Re-engineered Visit for Primary Care (REV), a 30-month project that will gather evidence from 9 primary care sites and explore which factors during each visit could be linked with hospital discharge and admissions. The proposal identified 7 data collection tasks that will be performed as part of the research:

• Primary care site organizational characteristics survey
• Primary care site patient characteristics survey
• Work flow mapping preliminary interviews
• Process flow mapping
• Work flow mapping follow-up interviews
• Patient interviews
• Community agency interviews

Through these interviews and surveys, the researchers hope to identify which transitional care processes have the greatest effect on patient outcomes, including readmissions, and how they can be optimized. These findings, they wrote, will “provide insight on the components and themes that should be part of a re-engineered visit that will ultimately inform an effective intervention that can be tested in a diverse set of primary care clinics.”

The annual respondent burden, a required component of federal agency information collection activity proposals, was estimated at $11,500.30. This figure takes into account the anticipated hours per response and average hourly wages of the primary care staff, patients, and social workers to be interviewed in the project.

This estimated burden pales in comparison to the $41.3 billion cited in the proposal as the annual hospital costs of readmissions. By gathering data on opportunities for improvement in primary care, the research project could “address the important and unfulfilled need to improve patient safety and reduce avoidable readmissions within the primary care context,” according to the proposal.