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Alan Podawiltz, Brenda Gomez and Wayne Young

JPS Health Network (JPS) has won the Texas Hospital Association’s 2014 Bill Aston Award for Quality. The statewide award recognizes Trinity Springs Pavilion’s successful campaign to lower the psychiatric hospital’s readmission rate, which has dropped by two thirds for patients most at risk.

The project was led by Alan Podawiltz, DO, Chair of Psychiatry and Behavioral Health at UNT Health Science Center, and Wayne Young, JPS Senior Vice President and Behavioral Health Administrator at Trinity Springs Pavilion.

The project began when JPS leaders discovered that too many of the patients discharged from Trinity Springs Pavilion, a 96-bed inpatient psychiatric facility, returned within 30 days.

The work included an analysis of electronic medical record data, in-depth chart reviews and interviews with patients, said Brenda Gomez, Director of Behavioral Health Social Services & Outpatient Clinics.

“Everybody knew what our readmission rate was, but we didn’t know which patients were coming back or why,” she said.

The result was a new risk assessment tool, which predicts a patient’s likelihood of being readmitted within 30 days of discharge. Gomez’ team identified 10 variables related to readmission. Substance abusers are more likely to require readmission, as are patients with severe psychiatric disorders. A patient’s age, ethnic background and ZIP code can also raise the odds.

By identifying high-risk patients and implementing personalized intervention strategies, JPS’ Discharge Management Improvement Project has lowered the readmission rate for high-risk patients from about 16 percent to 5 percent in less than a year.

Team members identified patients at risk for readmission by interviewing patients who had been readmitted, manually reviewing 250 charts and completing a data analysis on more than 3,800 discharges. They then developed personalized transition intervention strategies.

Some patients leave with medication in hand rather than a prescription. Others meet with a clinical pharmacist to better understand the medication regimen. Additional options include calls from peer-support specialists, home visits, or following up with the pharmacy to make sure the patient is getting prescriptions refilled.

Preventing readmissions creates efficiencies in health care delivery.

It’s also “just the right thing to do,” Young said. “If you are in need of inpatient psychiatric treatment, it means you are not successfully participating in the activities that make our lives enjoyable and fulfilling. If there are things we can do to help our patients avoid that, then that’s what we should be doing.”

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