Hospital Readmissions

A great deal of effort continues to be spent on hospital readmissions and their prevention.  The most recent issue of JAMA has several studies and analyses on the issue.   (JAMA Issue)   The subject continues to be very timely, given that the CMS penalty program started this year.  One analyses notes the continuing lack of clear evidence that readmission rate is a quality indicator.  Another notes the concern for any pay for performance program of the possible gaming of the coding systems used to compile data for most of these programs.  One study looked at patterns of readmissions, finding that the diagnoses were often different from the original hospitalization diagnoses, that readmissions occurred regularly throughout the typical 30-day period used to judge inappropriate admissions and that few, if any, patient characteristics seem associated with likely readmissions.  Another study noted that many recent dischargees have emergency room visits as well, so care transitions should focus on those as well as readmissions.  Pediatric readmissions were studied in one report, with a finding of variability across hospitals and across admission conditions.  The association between a care transition quality improvement effort and rehospitalizations was found to be generally lacking, with no change in the rate as a percent of hospital discharges, although the absolute number of hospitalizations and readmissions did decline.  The net effect left on the reader is the conclusion that most readmitted patients are just very sick and probably need to be in the hospital to get adequate care; demonstrating once again both the futility and punitive nature of the CMS program.