In May 2009 IHI launched the STate Action on Avoidable Rehospitalizations (STAAR) initiative — a groundbreaking, multi-state, multi-stakeholder approach to dramatically improve the delivery of effective care at a regional scale. The STAAR initiative aims to reduce rehospitalizations by working across organizational boundaries and by engaging payers, stakeholders at the state, regional and national level, patients and families, and caregivers at multiple care sites and clinical interfaces. IHI partners with STAAR states to provide strategic guidance, support and technical assistance to hospitals and cross-continuum teams to improve transitions in care and reduce avoidable rehospitalizations.
IHI currently works with three states through the STAAR initiative: Massachusetts, Michigan, and Washington. As the work progresses, IHI will make programming and information available for other states, regions, or organizations across the continuum to learn from the initiative.
Hospitalizations account for nearly one-third of the total $2 trillion spent on health care in the United States. In the majority of cases, hospitalization is necessary and appropriate. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay. These rehospitalizations are costly, potentially harmful, and often avoidable. The STAAR initiative is grounded in a two-part strategy for reducing rates of rehospitalization.
1. Improve transitions of care by cultivating a cross-continuum learning collaborative.
Delivering high-quality health care requires crucial contributions from many parts of the care continuum, and effective coordination and transitions between providers and between care settings. The best transition out of the hospital will only be as effective as an activated reception into the next setting of care. The core processes, communication tools and norms, handoff and follow-up delineations of responsibility and care coordination activities are all ripe for improvement.
STAAR participants are required to engage partners from across the continuum of care to problem-solve and co-design improvements in the day to day work of providers. The initiative supports the process improvement work in hospitals and cross-continuum teams by creating a robust learning community. STAAR provides content reviews, process recommendations, inventory and celebration of best practices, and suggested measurement strategies. Best practices and experienced faculty are drawn from successful teams that have worked with IHI in prior engagements.
2. Engage state-level leadership to understand and mitigate systemic barriers to change.
Reducing avoidable rehospitalizations in a state or region requires not only front-line process improvement, but also identification and mitigation of barriers to system-wide improvement, especially policy and payment reforms that will reduce fragmentation and encourage coordination across the continuum of care. Such reforms are necessary to address the shortcomings of the current volume-based incentives, and to place a premium on the quality of the patient’s experience across the continuum of care.
Prioritizing longitudinal care and reducing avoidable rehospitalizations involves new behaviors, norms, relationships, and partnerships to communicate and coordinate care between disciplines, settings, and organizations. State-level leadership is essential to understand and act on the barriers that front-line teams encounter in doing this work. Similar in many respects to the cross-continuum team at the provider-level, STAAR engages with multi-stakeholder state leaders and steering committees to lead and coordinate this initiative at the state level. This is especially relevant in states coordinating several ACA and delivery reform initiatives simultaneously.