Hospital Readmissions

As hospital readmissions become the focus of quality programs, researchers are looking to understand what factors may be related to readmissions, or even predict their likelihood.  A new study reported in the Journal of the American Medical Association used data from a multi-country drug study to look at variations in readmissions across countries and to ascertain variables linked to higher likelihoods of readmissions.   (JAMA Article)   The study included about 5770 patients from 17 countries, all of whom had suffered a heart attack.   As might be expected they found very significant variation across countries in readmission rates, almost a fourfold range of rates.  Overall, about 14.5% of US patients and 10% of non-US patients were readmitted within 30 days.  When elective readmissions were excluded, the difference was still quite large;  10.5% of US patients against 7.7% of those from other countries.

The authors looked at a large variety of demographic, clinical and care characteristics to determine what factors might be associated with and possibly predictive of rehospitalization.  Some factors that appeared to be linked include multi-vessel disease, higher rates of comorbidities and more in-hospital complications, which makes sense since these all just suggest a sicker patient to begin with.  After adjusting, multi-vessel disease, baseline heart rate, location of the disease in the heart, hypertension, and COPD were associated with greater likelihood of readmission, again all seeming to be consistent with the common sense notion that a sicker patient is likely to stay sicker and need more medical care.  However, the only factors that seem related to non-elective readmissions are baseline heart rate, and country-wide length of stay.  In fact, the strongest factor appeared to be country-wide length of stay and it seems to largely explain why US patients have higher readmission rates than those in other countries.  Our length of stay for heart attack is the lowest by far.

Right now, the state of the research on hospital readmissions suggests that, very importantly, there may not be much a hospital can do to prevent readmissions, since it is hard to predict who might need to be readmitted, and, even more importantly, that readmission rates are linked to lengths of stay in an inverse fashion, and that linkage may be the strongest factor in predicting overall readmission rate.  Since the government, and many private payers, are reimbursing hospitals by DRG and similar methods that encourage hospitals to be efficient in getting patients discharged quickly, but that practice appears to lead to more readmissions, which these public and private payers don’t want, it seems obvious that either hospital reimbursement has to change, or we stop worrying about readmissions.