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The Relationship Between Hospital Admission Rates and Rehospitalizations

The Article: Epstein, A.M., Jha, A.K., & Orav, E.J.  (2011). The relationship between hospital admission rates and rehospitalizations. New England Journal of Medicine, 365(24): 2287-2295.

The Big Idea: Preventing rehospitalizations is a big deal right now, especially as hospitals move towards an Accountable Care Organization (ACO) structure. Most rehospitalization efforts focus on enhancing transition care. However, these authors believe regional practice culture related to hospital admissions and access to healthcare professionals may have more impact on hospital readmissions than so-called lacking transitional care. This study utilized Medicare data to identify the 30-day, 60-day, and 90-day readmission rates for pneumonia and congestive heart failure patients ages 65 and older within 306 hospital referral regions (HRR).

Survey Says!: The authors found HRRs with hospitals with greater numbers of beds, greater numbers of specialists (cardiologists and pulmonologists), and generally higher numbers of admission rates had increased readmission rates, as well. In addition, this study did reinforce inadequate discharge planning as a factor for hospital readmission.

Quotable: “The severity of illness and the presence or absence of coexisting conditions affect the likelihood that an individual patient will be rehospitalized [references]” (p. 2288).

“Ideally, we would have focused our analyses on unplanned, preventable rehospitalizations. However, there is no consensus on how to identify preventable hospitalizations. As a second sensitivity analysis, we repeated our models but excluded readmissions with a primary diagnosis that indicated admission for chemotherapy or surgery performed on a nonurgent basis” (p.2289).

“The quality of transitional care is in need of substantial improvement (reference): many elderly patients fail to receive any ambulatory care before readmission (references), and only a minority of primary care physicians report receiving key discharge information about their recently hospitalized patients (reference). Such findings have prompted policymakers to focus on transitions in care between the hospital and the ambulatory setting as a way to reduce readmissions. Although these efforts probably prevent some readmissions, our findings underscore the importance of the general use of hospital care and suggest that policy initiatives such as creating a shared savings program with an accountable care organization might be effective in lowering rates of readmission as well” (p. 2293).

So What?: I’ve read a lot about preventing hospital readmissions via improved transitional care; this article stretched me. It is full of very complicated statistical methods and terms (at least for me!) and exposed me to some new national data sets I did not know existed. Hospital readmissions are obviously complex and multifactoral. There is no magic solution; still, moving towards an ACO payment structure will likely give organizations an incentive to change providers’ practices and promote proper service utilization among all.