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Appropriate Health Care Utilization

Reducing unnecessary health care resource utilization, specifically unnecessary admissions, readmissions and emergency room visits, is a key strategy for organizations preparing to thrive in the changing health care environment. A 2015 Minnesota Department of Health report, An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota, summarizes Minnesota's experience.

ICSI is engaged and has been leading the way in numerous efforts aimed at improving the health of the population, the patient experience, and the affordability of care, including appropriate health care utilization.

From 2011-2014 ICSI focused on reducing avoidable readmissions. Together with the Minnesota Hospital Association and Stratis Health, the Eisenberg award-winning Reducing Avoidable Readmission (RARE) Campaign engaged 84 Minnesota hospitals and over 100 community partners resulting in preventing 7,975 avoidable readmissions. Visit the RARE website to learn more.

  • Prevented 7,975 avoidable readmissions within 30 days of discharge
    through December 31, 2013
  • Recaptured 31,900 nights of patients’ sleep in their own beds
  • Helped reduce inpatient hospital expenditures by more than $70 million

RARE Mental Health Collaborative

From 2014 -2015, a mental health collaborative was convened. This extension of the RARE Campaign engaged 12 hospitals with inpatient mental health units to improve the care transitions of their patients and reduce readmissions. Learn more in this report or on the RARE website.

Exploring Appropriate Health Care Utilization

As the evidence continues to emerge on how to reduce unnecessary admissions, readmissions and emergency room visits, various theories have been developed regarding the clinical practice transformation needed to affect change. These proposed methods, improvement activities, measures, and outcomes need to be studied in a real world laboratory before they can be spread across Minnesota.

In 2015, ICSI convened a group of stakeholders to study the opportunities to further address unnecessary utilization in the areas of readmissions, admissions and emergency room use. This group’s findings are summarized as follows:

  • Work on readmissions continues, but work upstream could prevent both the admission and the readmission. Some systems are currently engaging in this work.
  • The commonly used definition of potentially preventable admissions (Ambulatory Care Sensitive Conditions) may be a useful surveillance metric, but it’s not useful for care model redesign and monitoring the impact of specific interventions.
  • Evidence on the best practices for reducing admissions and emergency department (ED) visits is being developed but is not definitive at this time.
  • Lagging data indicators on admission rates, readmission rates and total cost of care are currently available through Minnesota Community Measurement and the Minnesota Department of Health. However, leading, real-time indicators are not present and need to be explored.
  • There is variation among providers in admission rates, rates of ED visits, quality and cost. We need to learn from this variation and the practices that drive it.

Updated 03/02/16