What is the impact on the readmission ratio of taking into account readmissions to other hospitals? A cross-sectional study

Abstract

ObjectivesReadmissions are used widespread as an indicator of the quality of care within hospitals. Including readmissions to other hospitals might have consequences for hospitals. The aim of our study is to determine the impact of taking into account readmissions to other hospitals on the readmission ratio.Design and settingWe performed a cross-sectional study and used administrative data from 77 Dutch hospitals (2 333 173 admissions) in 2015 and 2016 (97% of all hospitals). We performed logistic regression analyses to calculate 30-day readmission ratios for each hospital (the number of observed admissions divided by the number of expected readmissions based on the case mix of the hospital, multiplied by 100). We then compared two models: one with readmissions only to the same hospital, and another with readmissions to any hospital in the Netherlands. The models were calculated on the hospital level for all in-patients and, in more detail, on the level of medical specialties.Main outcome measuresPercentage of readmissions to another hospital, readmission ratios same hospital and any hospital and C-statistic of each model in order to determine the discriminative ability.ResultsThe overall percentage of readmissions was 10.3%, of which 91.1% were to the same hospital and 8.9% to another hospital. Patients who went to another hospital were younger, more often men and had fewer comorbidities. The readmission ratios for any hospital versus the same hospital were strongly correlated (r=0.91). There were differences between the medical specialties in percentage of readmissions to another hospital and C-statistic.ConclusionsThe overall impact of taking into account readmissions to other hospitals seems to be limited in the Netherlands. However, it does have consequences for some hospitals. It would be interesting to explore what causes this difference for some hospitals and if it is related to the quality of care.

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

“…Hospital readmissions are a well-known problem in healthcare services worldwide1–5 with the hospital discharge process as an influential factor 6–8. Hospital discharge procedures play a critical role in the quality of transitional care, specifically on the continuity of information about patients’ treatments, or recommendations for further care 6.…”

Clinical characteristics and risk factors of preventable hospital readmissions within 30 days

“…Also, readmissions to other hospitals were not included in the cohort. A previous Dutch study showed only 8.9% of readmissions taking place in another hospital 28 , so we believe this small percentage did not influence the results. Finally, although we had an extensive review method for readmissions, there is still a possibility that some PPRs were missed during the evaluation process.…”

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

“…Hospital readmissions are recorded globally as metrics for quality of care 40–44 . Several European countries, including Italy, Denmark, Sweden and the Netherlands, make hospital readmission rates available to the public to allow for informed decision making 40,42,45 .…”

“…In this setting, readmissions are unlikely to occur to the index hospital and will not be included in quality reports. As rates of different‐hospital readmissions vary by hospital type and healthcare system, they are not a reliable measure of all readmissions 6,43,44,47 …”