Better Followup May Not Prevent Hospital Readmissions

Preventing hospital readmissions is one of the major quality improvement priorities in our health system.  Medicare is slated to introduce financial penalties for inappropriate readmissions in the near future.  Policymakers have suggested that readmissions could be avoided by better planning for follow-up, and better care management at transition out of the hospital.   Some research on heart failure patients supports that notion.  A new study published in the Archives of Internal Medicine, however, suggests that better discharge planning may not help prevent readmissions in general medicine patients.   (Archives Article)

The study looked at several thousand discharge summaries from patients in the Mayo Clinic’s hospital system to examine the effects of scheduling a timely follow-up visit on readmissions.   The endpoints included mortality, hospital admissions and emergency room visits.  About 60% of the discharge records had detailed follow-up appointment instructions.   There was no association between the instructions and death, reduced hospitalizations or emergency room visits after 30 days.   After 180 days, those patients with follow-up instructions were more likely to have had a hospitalization or an emergency room visit.

Interestingly, the longer the time to the follow-up appointment, the less likely a patient was to be readmitted within 30 days.  Also of interest is that only about 40% of readmissions and 35% of emergency room visits were related to the original admission.  Twelve percent of the readmissions which were related were for complications.  One significant weakness of the study is that the researchers did not assess whether the patients actually went to the follow-up visit.  As the researchers note, the results of the study suggest that using readmissions as a quality indicator may be flawed and may lead to unintended consequences, such as keeping patients longer, not accepting patients with difficult treatment needs or discharging patients to more intensive settings, such as nursing homes.