UCLA

Abstract

As the eighth leading cause of death in the United States, pneumonia (PN) is relevant to the health of the elderly and the young. Accountability for readmission is part of the Affordable Care Act’s Hospital Readmissions Reduction Program (RRP), which levies penalty costs for readmissions. RRPs influence patients with pneumonia, accounting for over 1.1M discharges and comprising 18.5% of all readmissions. Since pneumonia is one of the targets of the RRP, this research proposes that purposeful communication using framing effects can motivate patients to make decisions with providers for care post discharge and can prevent readmissions. Communication strategies (CS), such as framing effects, are known to facilitate decision-making about health care choices. Framing effects as a method of reducing readmission have not been tested in the condition of pneumonia and the process of making decisions for care post discharge.

Specific Aims:

1. To compare the communication strategies (intervention) of framing effects (positive or negative messages) on the readmission outcome at 30 days post discharge.

2. To assess the extent pneumonia readmissions decrease at 30 days post discharge when communication strategies (CS) include the patient or family in decisions about transitions.

3. To determine the impact of agreement between patients and HCPs on recommendations for post hospital care.

4. To examine the potential confounding effects on the relationship between framing effects and readmission rates of age, pneumonia severity index (PSI), and the number of diagnoses.

Design and Data Analysis

This is a double-blind randomized control trial (RCT) with parallel assignment of pneumonia patients to one of three arms. The independent variable (IV) is the communication strategy (framing effects), and the dependent variable (DV) is the readmission. The sample randomized each group (N = 156); three participants were excluded: Intervention A: positive framing, n = 44, Intervention B: negative framing, n = 65, and control group, n = 44.

Conclusion: Findings suggest that framed messages aid in the reduction of pneumonia readmission rates in hospitals. The decision-making strategy incorporates education and understanding of risk by the patient, so the healthcare team can encourage and improve readmission outcomes.