Same-hospital Readmission Research Articles

Is Same-Hospital Readmission Rate a Good Surrogate for All-Hospital Readmission Rate?

The Centers for Medicare & Medicaid Services (CMS) readmission measure is based on all-cause readmissions to any hospital within 30 days of discharge. Whether a measure based on same-hospital readmission, an outcome that is easier for hospitals and some systems to track, could serve as a proxy for the all-hospital measure is not known. Evaluate whether same-hospital readmission rate is a good surrogate for all-hospital readmission rate. The study population was derived from the Medicare inpatient, outpatient, and carrier (physician) Standard Analytic Files. Thirty-day risk-standardized readmission rates (RSRRs) for heart failure (HF) for both all-hospital readmission and same-hospital readmission were assessed by using hierarchical logistic regression models. The sample consisted of 501,234 hospitalizations in 4674 hospitals with at least 1 hospitalization. Thirty-day readmission was defined as occurrence of at least 1 hospitalization in any US acute care hospital for any cause within 30 days of discharge after an index hospitalization. Same-hospital readmission was considered if the patient was admitted to the hospital that produced the original discharge within 30 days. Overall, 80.9% of all HF readmissions occurred in the same- hospital, whereas 19.1% of readmissions occurred in a different hospital. The mean difference between all- versus same-hospital RSRR was 4.7 +/- 1.0%, ranging from 0.9% to 10.5% across these hospitals with 25th, 50th, and 75th percentiles of 4.1%, 4.7%, and 5.2%, respectively, and was variable across the range of average RSRR. Same-hospital readmission rate is an unreliable and biased indicator of all-hospital readmission rate with limited value as a benchmark for quality of care processes.

Association of physical functioning with same-hospital readmission after stroke.

Readmission after hospitalization for stroke is an important outcome. We sought to document the frequency of same-hospital readmission and to determine the relative value of physical functioning as a predictor of the outcome. Consenting patients (n = 228) who were admitted for ischemic stroke were characterized according to demographics, stroke severity, and self-reported prestroke and postadmission physical functioning. The hospital's administrative database was used to track readmissions during the year after index hospitalization. Same-hospital readmissions were experienced by 37.3% of the patients. The readmissions usually occurred within 100 days of discharge. The most common readmission diagnosis was stroke (14.1%). Lower prestroke and postadmission physical functioning (as reflected by dichotomous Barthel index scores) were weak but significant predictors of readmission (r = -0.165 and -0.268, respectively). Regression analysis showed that once postadmission physical functioning was accounted for, neither prestroke functioning nor any other measured variable added to the explanation of same-hospital readmission. The importance of physical functioning goes beyond rehabilitation. It is a potentially modifiable variable with implications for readmission.