Hospitals may take too much of the blame for unplanned readmissions

July 12, 2018, Beth Israel Deaconess Medical Center
Credit: CC0 Public Domain

A major goal of hospitals is to prevent unplanned readmissions of patients after they are discharged. A new study reveals that the preventability of readmissions changes over time: readmissions within the first week after discharge are often preventable by the hospital, whereas readmissions later are often related to patients' difficultly accessing outpatient clinics.

"Patients discharged from a are usually recovering from a serious medical condition as well as managing other , and they often encounter new logistical challenges adapting to this recovery period," said Kelly Graham, MD, MPH, Director of Ambulatory Residency Training at BIDMC and an Instructor in Medicine at Harvard Medical School. "Hospitals and outpatient clinics must work together more seamlessly to ensure that patients are equipped to manage these challenges at home."

For their study, published in the Annals of Internal Medicine, Graham and her colleagues examined information on 822 general medicine patients readmitted to 10 in the United States. Overall, 36.2% of early readmissions versus 23.0% of late readmissions were deemed preventable. Hospitals were identified as better locations for preventing early readmissions, whereas outpatient clinics and home were better for preventing late readmissions.

Premature and problems with physician decision-making related to diagnosis and management during the initial hospitalization were likely causes of readmissions in the early period. More likely to be amenable to interventions outside the hospital, later readmissions were most often caused by factors over which the hospital has less direct control, such as monitoring and managing of symptoms after discharge by clinicians, as well as end-of-life issues.

Taken together, the findings suggest that readmissions in the week after discharge are more preventable and more likely to be caused by factors over which the hospital has direct control than those later in the 30-day window. In the current US system, however, unplanned readmissions within the 30 days after hospital discharge are considered uniformly preventable by hospitals, and thus hospitals are punished with financial penalties for these events.

"Our findings suggest that the 30 days following hospital discharge are not the same with regard to what influences outcomes for sick patients, and that the current model over-simplifies this high-risk time," said Graham. "One potential unintended consequence of this is that outpatient environments have not been involved in efforts to manage this high-risk timeframe, which results in poorly coordinated care and worse outcomes for our ."

Graham noted that interventions to improve outcomes after should engage the ambulatory care system, with attention to improving access to primary care. "We should also be careful not to put too much focus on reducing length of stay in the hospital, which may be a driver of premature discharge and early readmissions," she said.

Explore further: Early readmissions more preventable than later ones

Related Stories

Early readmissions more preventable than later ones

May 1, 2018
(HealthDay)—Early general medicine readmissions are more likely than late readmissions to be preventable with hospital-based interventions, according to a study published online May 1 in the Annals of Internal of Medicine.

Dementia increases the risk of 30-day readmission to the hospital after discharge

February 23, 2018
About 25 percent of older adults admitted to hospitals have dementia and are at increased risk for serious problems like in-hospital falls and delirium (the medical term for an abrupt, rapid change in mental function). As ...

Single 30-day hospital readmission metric fails to reflect changing risk factors

June 2, 2015
A new study from researchers at Beth Israel Deaconess Medical Center (BIDMC) suggests that risk factors for readmission change significantly over the course of the 30 days following hospital discharge. Thirty-day hospital ...

Study: Reducing hospital readmissions does not increase mortality rates

July 18, 2017
Recent advances in reducing hospital readmission rates for three key medical conditions occurred without causing an increase in death rates, according to a new Yale-led study.

Hospital readmission rates not accurate measure of care quality

August 22, 2011
Avoidable readmissions after discharge from hospital are fairly uncommon and are not an accurate measure of quality of care, found a study in CMAJ (Canadian Medical Association Journal).

Hospital quality linked to readmission rates for COPD and other diseases

March 21, 2017
Nearly one in five patients admitted to hospitals in the United States are readmitted within 30 days, at a cost of $17 billion annually. To reduce readmission rates, the federal Centers for Medicare & Medicaid Services (CMS) ...

Recommended for you

Study analyzes numbers, trends in health care data breaches nationwide

September 25, 2018
Health plans—entities that cover the costs of medical care—accounted for the greatest number of patient records breached over the past seven years, according to an analysis of U.S. health care data conducted by two Massachusetts ...

Genes may control how tough it is to stop drinking

September 25, 2018
(HealthDay)—When they give up booze, some alcoholics have more severe withdrawal symptoms than others. This discrepancy may come down to genetics, researchers say.

Why industry influence on research agendas must be addressed

September 25, 2018
Industry influence on the research agenda—and the tactics employed by tobacco, pharmaceutical, food, mining, chemical and alcohol companies to drive questions away from those most relevant to public health—is the focus ...

New study finds concurrent use of prescription drugs and dietary supplements could pose health risks

September 25, 2018
A new University of Hertfordshire study found that using certain over-the-counter herbal medicines and dietary supplements alongside prescription drugs could pose serious health risks, especially amongst older adults.

Most nations falling short of UN targets to cut premature deaths from chronic diseases

September 21, 2018
People in the UK, US and China have a higher risk of dying early from conditions like cancer, heart disease and stroke than people in Italy, France, South Korea and Australia.

It's not just for kids—even adults appear to benefit from a regular bedtime

September 21, 2018
Sufficient sleep has been proven to help keep the body healthy and the mind sharp. But it's not just an issue of logging at least seven hours of Z's.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.