Evansville is one of 14 communities named by the Centers for Medicare & Medicaid Services (CMS) to a three-year pilot project aimed at eliminating unnecessary hospital readmissions.

The goal of the Care Transitions Project is to improve health care processes so that patients, their caregivers and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care.

“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital readmissions occur locally and how patients transition between health care settings,” explained Barry M. Straube, M.D., chief medical officer for CMS. “Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of readmissions.”

The project comes just after a study last month in the New England Journal of Medicine reported nearly one-fifth of Medicare patients who had been discharged from a hospital were rehospitalized within 30 days. The estimated cost to Medicare for unplanned rehospitalizations in 2004 was $17.4 billion.

Each selected community will be led by a state Quality Improvement Organziation (QIO), which will work with partners to implement:

• Hospital and community system-wide interventions
• Interventions that target specific diseases or conditions
• Interventions that target specific reasons for admission

CMS will monitor the success of the project by watching the rates at which patients in these communities return to the hospital. Readmission rates for hospitals have been tracked by CMS for some time and will be available to the public on the Hospital Compare Web site here.

The Care Transitions Project is expected to continue in all 14 communities through 2011. Find information about the project here.

Learn about the QIO here.

Read about the New England Journal of Medicine study here.