Single 30-day hospital readmission metric fails to reflect changing risk factors

Single 30-day hospital readmission metric fails to reflect changing risk factors.

From the 3 June 2015 P & T news release

Separate 8-day and 30-day benchmarks would better inform readmission prevention strategies, authors say

A new study from researchers at Beth Israel Deaconess Medical Center suggests that risk factors for readmission change significantly over the course of the 30 days following hospital discharge. Thirty-day hospital readmission rates have become a federal quality metric intended to reflect inpatient quality of care and unnecessary health-care utilization.

Published June 2 in the Annals of Internal Medicine, the research suggests that two distinct 8-day and 30-day readmission rates would serve as better inpatient quality measurements and would better inform readmission prevention strategies.

…

he authors also noted that other research has shown that hospitals that strictly follow evidence-based care standards do not necessarily have the lowest readmission rates and that readmission rates do not serve as a benchmark for inpatient mortality. Under the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services may reduce payments to acute-care hospitals deemed to have excess readmissions within 30 days of discharge.

The study also found that discharges between 8 a.m. and 12:59 p.m. were associated with lower odds of an early readmission. The authors noted that discharge in the first part of the day likely gave patients and their families more time to access community resources such as pharmacies and social supports, thereby reducing the likelihood of readmission.

The authors also found that social determinants of health are closely tied to readmissions, as they affect how patients access care. They evaluated the effect of barriers to health literacy on readmissions and found that they were associated with both early and late readmissions. A patient’s insurance status was also relevant among those readmitted in the late period; patients with unsupplemented Medicare or Medicaid were more likely to be readmitted 8 or more days after discharge.

“The growing movement toward accountable-care organizations and patient-centered medical homes may prove beneficial in preventing unnecessary hospital readmissions,” Graham said. “Patients discharged from the hospital need support from and teamwork among hospitalists, primary care physicians, nurse practitioners, visiting nurses, pharmacists, and others.”

The authors stressed that both hospital and outpatient settings need systems of care that closely monitor patients as they transition their medical care from the hospital team back to the primary care team. Post-discharge monitoring would better enable a team to make sure patients adhere to the detailed care plan designed by the hospital team, such as taking medications correctly and keeping follow-up appointments.

Source: Beth Israel Deaconess Medical Center; June 2, 2015.

[press release] Reducing Hospital Readmission Rates Will Require Community-Focused Effort

From the Wiley press release (February 2015)

Recent research indicates that most of the variation in hospital readmission rates in the United States is related to geography and other factors over which hospitals have little or no control. Access and quality of care outside of the hospital setting seem to be especially important.

A new editorial that addresses these findings notes that a broader focus on community health systems, not just performance of individual hospitals, may be needed to reduce hospital readmissions.

Because high readmission rates trigger reductions in Medicare reimbursements to hospitals, facilities in socioeconomically disadvantaged and underserved communities may be disproportionately penalized. The editorial is published in Health Services Research.

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Access and quality outside the hospital may affect the degree to which the HRRP can achieve its intended outcome, fewer readmissions, but other factors are likely to determine whether the policy is an operational success. For the HRRP, operational success could be defined as whether hospitals respond in a manner consistent with the underlying motivations of improving quality of care and reducing costs. In terms of improving quality, a recent meta-analysis of randomized trials found that interventions designed to prevent readmissions tended be moderately effective (relative risk of 30-day readmission 0.82, 95 percent CI, 0.73–0.91). The studied interventions addressed care both during and after hospitalization, such as through case management, patient education, home visits, and patient self-management support, among other activities. Multifaceted interventions were more common and were 30–40 percent more effective than one-dimensional ones (Leppin et al. 2014), yet they may also be more challenging to implement and more costly. The degree to which hospitals nationwide are implementing quality improvement interventions that target readmissions does not appear to have been described.

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Hospital readmission rates linked to availability of care, socioeconomics

From the 11 May 2012 Eureka News Alert

American Heart Association meeting report – Abstract 12

Differences in regional hospital readmission rates for heart failure are more closely tied to the availability of care and socioeconomics than to hospital performance or patients’ degree of illness, according to research presented at the American Heart Association’s Quality of Care & Outcomes Research Scientific Sessions 2012.

U.S. regional readmission rates for heart failure vary widely ― from 10 percent to 32 percent ― researchers found. Communities with higher rates were likely to have more physicians and hospital beds and their populations were likely to be poor, black and relatively sicker. People 65 and older are also readmitted more frequently.

To cut costs, the Centers for Medicare and Medicaid Services plans to penalize hospitals with higher readmission rates related to heart failure, heart attack and pneumonia. Next year, hospitals with higher-than-average 30-day readmission rates will face reductions in Medicare payments.

But the penalties don’t address the supply and societal influences that can increase readmission rates, said Karen E. Joynt, M.D., lead author of the study and an instructor at Brigham and Women’s Hospital, Harvard Medical School and the Harvard School of Public Health in Boston, Mass….

Related articles

• Hospital Readmission Rates Linked to Availability of Care, Socioeconomics (newsroom.heart.org)
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Hospital readmission rates misleading

Hospital readmission rates misleading

From the Healthcare Informatics blog item

Readmission rates, for instance, do not take into account the complexity of correcting problems involving the spine, which often call for two or more staged surgeries spaced out over several weeks, says Mummaneni. Publicly reported readmission rates do not always take into account scheduled follow-up surgeries and unplanned hospital readmissions, causing the calculated rates to be over-estimated. Additionally, he said, this problem may present surgeons with a tough choice between scheduling multiple surgeries, which may be better for the patients, and scheduling single surgeries, which would improve readmission rate calculations.

A US Navy general surgeon and an operating room nurse discuss proper procedures while performing a laparoscopic cholecystectomy surgery. (Photo credit: Wikipedia)

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