Assessing preventability in the quest to reduce hospital readmissions

Lavenberg, Julia; Leas, Brian F; Umscheid, Craig A.; Williams, Kristina; Goldmann, David R.; Kripalani, Sunil

doi:10.1002/jhm.2226

Cited by 33 publications

(35 citation statements)

References 35 publications

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“…Each year, hospital readmissions affect 18.2% of Medicare beneficiaries (1) and cost Medicare between $15 and $17 billion (2). Effective October 1, 2012, Section 3025 of the Patient Protection and Affordable Care Act established the Hospital Readmissions Reduction Program, authorizing the Centers for Medicare and Medicaid Services to impose financial penalties on hospitals for excessive readmissions within 30 days of hospital discharge (3).…”

Section: Introductionmentioning

confidence: 99%

Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients

Graham

Auerbach

Schnipper

et al. 2018

Annals of Internal Medicine

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Background: Many experts believe that hospitals with more frequent hospital readmissions provide lower quality of care, but little is known about how the preventability of readmissions might change over the post-discharge timeframe. Objective: To determine whether readmissions within 7 days of discharge are different from readmissions between 8 and 30 days after discharge with respect to preventability. Design: Prospective cohort study. Setting: 10 US academic medical centers. Patients: 822 adults readmitted to a general medicine service. Measurements: At each site, 2 physician assessors used a structured survey instrument to determine whether each readmission was preventable and to measure other characteristics of the readmission. Results: 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference 13.0%, 25th, 75th percentile 5.5, 26.4). The hospital was identified as a better location to prevent an early readmission than a late readmission (47.2% vs. 25.5%, [median risk difference 22.8%, 25th, 75th percentile 17.9, 31.8]). In contrast, the outpatient clinic (15.2% vs. 6.6%, [median risk difference 10%, 25th, 75th percentile 4.6, 12.2]) and home (19.4% vs. 14%, [median risk difference 5.6%, 25th, 75th percentile −6.1, 17.1]) were identified as better locations to prevent late readmissions than early readmissions. Limitations: Physician assessors were not blinded to readmission timing. In addition, community hospitals were not included in the study, and readmissions to non-study hospitals were not included in the results. Conclusions: Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.

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Section: Introductionmentioning

confidence: 99%

Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients

Graham

Auerbach

Schnipper

et al. 2018

Annals of Internal Medicine

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“…In a study of septic shock survivors that focused on the cause of readmission, Ortego and colleagues found that 46% of 30-day readmissions were infection-related, including new, unresolved, and recurrent infections (17). Investigation is required to determine whether sepsis itself and/or the care provisions required to treat the acute illness (e.g., catheter-associated infections, transfusions [40]) confer increased readmission risk that may be preventable (41).…”

Section: Discussionmentioning

confidence: 99%

Post–Acute Care Use and Hospital Readmission after Sepsis

et al. 2015

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Rationale: The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.Objectives: To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods:In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.Measurements and Main Results: Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P , 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P , 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P , 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.Conclusions: Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.

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“…5 -11 A common criticism of using readmission rates as a health care quality measure is that many readmissions are not causally related to the hospital care provided during the index admission; rather, they may represent worsening of underlying chronic disease. 12,13 In addition, some argue that hospitals should not be held accountable for readmissions because factors that contribute to readmissions often are not hospital factors (eg, postoperative complication) but instead are outpatient (eg, nurse unable to visit home) or patient (eg, not taking prescribed medications) factors and thus beyond the hospital's direct control. 14,15 Currently, 3 main strategies for ascertaining the potential preventability of hospital readmissions include the following: claims-based algorithms, medical record review, and structured interviews.…”

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confidence: 99%