Keeping Mental Health Readmissions RARE

07 May 2014
It’s well known that the RARE (Reducing Avoidable Readmissions Effectively) Campaign has been highly successful in Minnesota. The most recent data from the third quarter 2013 show that participants have helped prevent 7,030 avoidable readmissions since 2011 and allowed patients in Minnesota to spend 28,120 nights of sleep in their own beds instead of in the hospital.
The RARE Campaign was launched in 2011 by the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association (MHA), and Stratis Health and supported by MN Community Measurement, leader of Aligning Forces in Minnesota, to address the fragmentation of the health care system that often leads to preventable hospital readmissions. Now the RARE Campaign is embarking upon a yearlong mental health care transitions collaborative to support the reduction of readmissions for patients in inpatient mental health units. This expansion into the area of mental health builds upon existing successes and established processes to treat an area of health care that has recently garnered significant national attention. Mental health is also an area with a high incidence of readmission; in 2010, depression was the fourth most common diagnosis for readmissions in Minnesota, according to MHA’s Potentially Preventable Readmissions (PPR) data.
Martha Burton Santibáñez, Aligning Forces for Quality & Community Engagement project manager with MN Community Measurement, was pleasantly surprised by the high level of interest in the program. “We originally had a goal of involving seven organizations, and now we have 13. It’s a really great example of the climate in Minnesota, where people want to look at the data and build to sustainable quality improvement efforts,” said Santibáñez.
For mental health patients, the transition to post-acute care can be complicated. Illnesses such as depression, bipolar disorder, and schizophrenia present unique vulnerabilities that call for heightened attention to care transitions. The importance of support from friends and family often goes unrecognized, potentially stemming from misunderstood privacy rules. Medication management can prove difficult as well.
Some medications are not available in an outpatient setting, and the sheer number of medications can be overwhelming. Medication side effects may cause patients to stop taking them once they are at home. Hospitalized patients may be impaired by their illness or simply confused by what they are experiencing. Other challenges, such as stigma associated with diagnosis, access to follow-up care, and socioeconomic challenges can also play a role in care transitions.
Kathy Cummings, RN, project manager at ICSI, explains how the RARE Mental Health Collaborative addresses some of the issues unique to mental health transitions. “You have to get permission from the patient to contact family, however the patient defines it. But, you may need to ask more than once during the stay to obtain releases as the patient’s condition changes,” she said.
“Each of the five focus areas—comprehensive transition planning, medication management, patient and family engagement, care transition support, and transition communication, has unique interventions when applied to the patient with mental illness. We must look at the whole patient to determine what they need to make a successful transition,” Cummings said. “Some patients may require a case manager to become involved and advocate for them at every step along the way, including connecting the patient to critical resources in the community. The Mental Health Collaborative also recognizes the importance of appointments with providers very shortly after discharge, ideally within 10 days.”
As the health care providers work through the collaborative, they are setting their own realistic but challenging goals to reduce their mental health readmissions. Some organizations hope to reduce readmissions by up to 20 percent. Said Santibáñez, “People are seeing the need to focus on mental health, and there is a clear understanding that better transitions are key to a good patient experience.”