- Case Study (755K PDF)
OverviewMemorial Hermann Memorial City Medical Center (Memorial City) achieved superior readmission rates in two of the three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS). Its readmission rate for patients with acute myocardial infarction (AMI) and pneumonia surpassed the best 10 percent of hospitals in the country for the selection period. Its readmission rate for heart failure was not as strong, outperforming the national average only by a narrow margin. (Exhibit 1)
Memorial City's achievement of low readmission rates for heart attack and pneumonia appears to be related to the Memorial Hermann Healthcare System's efforts to improve quality and patient safety for all patients. At each of the system's hospitals, staff have sought to provide high-quality, safe care consistent with the highest clinical standards and to avoid problems such as infections or falls that can exacerbate patients' underlying health problems. Memorial City, in particular, has achieved exceptionally high standards in AMI care. They also have increased attention to educating and supporting patients and linking patients—even the uninsured—to needed care after discharge, which likely reduces readmissions.
Specifically, the following efforts and patient-focused interventions, which were initiated by the system and implemented at the hospital, seem to contribute to Memorial City's low readmission rates:
- Emphasis on quality, with a clear leadership vision that is communicated to all clinical staff and backed up by the commitment of needed resources. The health system aims to "do the right thing the first time."
- Concurrent review of performance on core measures during a patient's stay to monitor achievement of goals, with findings reported to physicians.
- Extensive employee training related to the system's top priorities to make sure everyone is "rowing in the right direction."
- Planning for discharge begins upon admission, with staff actively educating patients about their disease and connecting patients with a source of ongoing care, even if they lack insurance coverage. The hospital offers a community-based disease management program for uninsured patients with chronic illness.
- Risk-assessment software helps case managers establish the appropriate level of care and assess a patient’s readiness for discharge.
- Pharmacists are located in high-risk units to provide medication education to patients and help simplify home medication regimens.
- Iterative process improvements in AMI care have resulted in a lower door-to-balloon time, which preserves heart muscle, thus reducing complications and the risk of readmission. Memorial City’s average door-to-balloon time is around 65 minutes, compared with the Joint Commission's standard of 90 minutes.
This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.