Physician Engagement in Quality Self-reflection as a Tool to Increase Hospitalist Participation in Readmission Quality Improvement Vipulkumar Rana, MD; Bipin Thapa, MD; Sumanta Chaudhuri Saini, MD; Pooja Nagpal, MD; Ankur Segon, MD, MPH; Kathlyn Fletcher, MD, MA; Geoffrey Lamb, MD Background: Reducing 30-day readmissions is a national priority. Although multipronged programs have been shown to reduce readmissions, the role of the individual hospitalist physician in reducing readmissions is not clear. Objectives: We evaluated the effect of physicians’ self-review of their own readmission cases on the 30-day read- mission rate. Methods: Over a 1-year period, hospitalists were sent their individual readmission rates and cases on a weekly basis. They reviewed their cases and completed a data abstraction tool. In addition, a facilitator led small group discussion about common causes of readmission and ways to prevent such readmissions. Results: Our preintervention readmission rate was 16.16% and postintervention was 14.99% (P = .76). Among hospitalists on duty, nearly all participated in scheduled facilitated discussions. Self-review was completed in 67% of the cases. Conclusions: A facilitated reflective practice intervention increased hospitalist participation and awareness in the mission to reduce readmissions and this intervention resulted in a nonsignificant trend in readmission reduction. Key words: hospitalists, quality improvement, readmissions, self-review R educing readmissions has become a national priority because of the perceived cost savings from avoiding potentially preventable readmissions, driven in large part by the Centers for Medicare & Medicaid Services’ penalties for excess readmissions. Until 2009, nearly 1 out of every 5 Medicare ben- eficiaries discharged from a hospital returned within 30 days at a cost of close to US$17 billion. 1 As a re- sponse the recently enacted Affordable Care Act has a provision to reduce payments to hospitals with ex- cess readmissions—the hospital readmissions reduc- tion program (HRRP). In the third year of enforcement of the HRRP (2014), 2610 hospitals had up to 3% of their Medicare reimbursement reduced as a result of excess readmissions. 2 The HRRP effectively places the accountability of reducing readmissions on hos- pitals. Accordingly, many interventions have been im- plemented by hospitals to reduce readmissions with Author Affiliations: Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee (Drs Rana, Thapa, Nagpal, Segon, Fletcher, and Lamb); and Division of General Internal Medicine, University of California, Riverside (Dr Saini). Correspondence: Vipulkumar Rana, MD, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226 (vrana@mcw.edu). The authors would like to thank the following people/groups for their support and contributions to this research: Siddhartha Singh, MD; Lee A. Biblo, MD; Ann Nattinger, MD; Julie Mitchell, MD; David Marks, MD; Mary Conti, RN; Janice Hawthorne, AA; Section of Hospital Medicine at the Medical College of Wisconsin. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare that there is no conflict of interest. Q Manage Health Care Vol. 25, No. 4, pp. 219–224 Copyright C  2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/QMH.0000000000000111 no reliable impact. 3,4 Some of these include pharma- cist review of discharge medications, 5,6 comprehensive discharge review, 7,8 primary care physician (PCP) visits within a few days of discharge, 9,10 posthospitalization phone calls, 11,12 and home care visits by nurses. 13 The most successful have been bundles of care, which in- clude a number of these interventions combined with others. 14-17 Despite this, many hospitals are turning to their hospitalists (physicians dedicated to the compre- hensive care of the hospitalized patient) to help address the problem of high readmissions. 14,15,18 Previous work on reducing readmissions by hospital- ists includes review of readmissions by a select group of hospitalists as well as review of communications between inpatient providers after a readmission. 9,18 A recent report from the Mayo Clinic goes further to sug- gest that hospitalist review of their own readmissions with self-reflection led to a substantial reduction in readmissions. 19 Such an approach is attractive and if effective, relatively easy to implement. As such, we designed an intervention to build on this previous work by asking the hospitalists at our institution to review and reflect on their own readmissions as well as share potential learnings via discussion in a larger group. We hypothesized that a combination of physician education regarding the problem of readmissions and self-review with learning of potential causes of readmissions in his/her own practice would allow each practitioner to adjust his/her practice to prevent future similar errors or oversight on discharge. 20-23 STUDY DESIGN AND METHODS Setting The study took place in a 490-bed urban, tertiary care academic medical center in the Midwestern United Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. October–December 2016  Volume 25  Number 4 www.qmhcjournal.com 219