Overview

Reduce the Cost of Care

Cleveland Clinic All Cause 30-day Readmission Rate to any Cleveland Clinic Hospital

2018 – 2021

CCHS = Cleveland Clinic health system

Cleveland Clinic monitors 30-day readmission rates for any reason to any of its system hospitals. Unplanned readmissions are actively reviewed for improvement opportunities. Comprehensive care coordination and care management for high-risk patients has been initiated in an effort to prevent unnecessary hospitalizations and emergency department visits. The COVID-19 pandemic contributed to an increase in readmission rates in 2020 and 2021.

Our efforts to decrease readmissions include:

  1. Daily Plan of Care Visits to coordinate care and discharge planning across the care team including the patient.
  2. Individualized Care Plans (ICPs) for patients with frequent hospital encounters.
  3. Readmissions risk score in electronic health record to focus efforts for highest risk patients.
  4. Timely follow-up visits following discharge to ensure smooth transition of care.