Background:The hospital readmission rate has been proposed as an important outcome indicator computable from routine statistics. However, most commonly used measures raise conceptual issues. Objectives: We sought to evaluate the usefulness of the computerized algorithm for identifying avoidable readmissions on the basis of minimum bias, criterion validity, and measurement precision. Research Design and Subjects: A total of 131,809 hospitalizations of patients discharged alive from 49 hospitals were used to compare the predictive performance of risk adjustment methods. A subset of a random sample of 570 medical records of discharge/readmission pairs in 12 hospitals were reviewed to estimate the predictive value of the screening of potentially avoidable readmissions. Measures: Potentially avoidable readmissions, defined as readmissions related to a condition of the previous hospitalization and not expected as part of a program of care and occurring within 30 days after the previous discharge, were identified by a computerized algorithm. Unavoidable readmissions were considered as censored events. Results: A total of 5.2% of hospitalizations were followed by a potentially avoidable readmission, 17% of them in a different hospital. The predictive value of the screen was 78%; 27% of screened readmissions were judged clearly avoidable. The correlation between the hospital rate of clearly avoidable readmission and all readmissions rate, potentially avoidable readmissions rate or the ratio of observed to expected readmissions were respectively 0.42, 0.56 and 0.66. Adjustment models using clinical information performed better. Conclusion: Adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance.

Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.

This is a comparative study of two groups of suicide attempters admitted in a general hospital, who were treated in different ways. The 143 attempters of the "systematically treated group (STG)" were proposed the classical therapeutic measures (supportive psychotherapy, psychiatric hospitalization, crisis interventions within couples or families, mixed interventions with the above treatments, psychoanalytically oriented psychotherapy, etc.), plus ambulatory controls (a few days after discharge from the general hospital, after one month, three months, six months, a year, and two years). The 145 attempters of the "reference group (RG)" were proposed the classical measures only. All the attempters of both groups had a follow-up after two years. The results suggest the controls to be probably responsible for the difference of relapses and committed suicides between the two groups. More indirectly, this study facilitated a further analysis of the relational problems between suicide attempters and staff, and among staff members themselves. The consequences were a modification of some attitudes of the staff toward the attempters and their significant others, and a new collaboration for an interdisciplinary clinical research.

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