Readmission Rates and Quality

There has been extensive debate about the extent to which hospital readmission rates reflect the level of quality at a hospital.   This is a separate issue from whether programs to reduce inappropriate readmissions are properly constructed to accomplish their goal.  A new study in the New England Journal of Medicine looked at a comparison of readmission rates after surgery with general markers of surgical quality at the hospital.   (NEJM Article)   Looking at readmissions related to surgery intuitively may be more reflective of quality than readmissions for medical conditions, since surgery is more discrete and a readmission may be more likely to be related to complications or other aspects of the procedure.  The researchers utilized data on Medicare patients undergoing one of six common surgeries at about 3000 hospitals.  They examined readmission rates, the structural characteristics of hospitals and performance on standard surgical quality measures.  Overall there was a 13.1% readmission rate within 30 days of discharge, with older and sicker patients more likely to be readmitted.  Lower readmission rates seemed to be associated with nonprofit hospitals, those that were not teaching centers, hospitals in the Western region of the US, and hospitals which treated fewer Medicaid patients.  There was substantial variation in readmission rates across hospitals.  Slightly lower readmission rates were associated with higher performance on a general measure of process quality.  Lower rates also occurred in hospitals with higher surgical volumes.  Having lower surgery mortality rates also was linked to fewer readmissions.  The overall relationship generally held for each of the six surgeries when examined individually.   The study suggests that there is a relationship between hospital quality and readmissions in regard to surgical hospitalizations, but the relationship is not particularly strong and may actually reflect patient or hospital characteristics that were not revealed in the study.