Abstract
BackgroundHospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.MethodsWe conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.ResultsThe review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.ConclusionsThe current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.
Highlights
Preventable hospital readmissions possess all the hallmark characteristics of healthcare events prime for intervention and reform
If a single common set of consistent patient-level risk factors can be distilled from this review it would include a variety of measures of poor-health or frailty: co-morbidities [5,25,27,30,32,38,39,40,44,46,55], increasing severity class [23,34,41], increasing age [5,26,27,41,53], general poor health [44,53,54], or high previous utilization of the healthcare system [5,29,30,41,44]
Some studies highlighted racial/ethnic disparities in preventable readmission for diabetics [31,41], patients with pulmonary embolism [23], and other preventable conditions [2]. These potential risk factors are common to other investigations of hospitalization
Summary
Preventable hospital readmissions possess all the hallmark characteristics of healthcare events prime for intervention and reform. Potentially avoidable events, it is not surprising that hospital readmissions are a leading topic of practice reform and healthcare policy. The Centers for Medicare and Medicaid Services recommended reducing payments for readmissions [14] and along with the National Quality Forum, has already defined some readmission as truly preventable and not worthy of reimbursement [15]. Joining this call for reducing preventable readmissions is the growing interest in bundled payments and accountable care organizations as means to improve healthcare quality and efficiency. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions
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