Abstract
BackgroundIt is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.ObjectiveCompare preventability of hospital readmissions, between an early period [0–7 days post-discharge] and a late period [8–30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.Design, setting, patients120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010MeasuresSum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.ResultsReadmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1–6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].ConclusionsReadmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.
Highlights
Hospital readmissions are a common and costly issue, affecting one in five hospitalized Medicare beneficiaries annually [1]
Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01]
Our sampling strategy ensured that 50% of our sample was derived from the pool of patients that were readmitted within 7 days of hospital discharge, and 50% of our sample was derived from the pool of patients that were readmitted between days 8–30 after hospital discharge
Summary
Hospital readmissions are a common and costly issue, affecting one in five hospitalized Medicare beneficiaries annually [1]. 30-day readmissions disproportionately affect patients with higher chronic illness burden [12,13,14], and lower socioeconomic status [15,16,17,18,19,20], rather than representing factors directly related to the index hospitalization, such as physician cognitive errors or problematic systems of care. A better metric would more closely represent preventable readmissions, a construct that is difficult to measure, but for which hospitals and their clinical teams are directly accountable. It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric
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