Hospital care quality more likely a factor in early versus late readmissions

The study authors called for readmission prevention efforts to either recognize shared accountability for readmissions along the entire spectrum of care or shrink the focus of penalties for hospitals to the first week after discharge.

Quality of hospital care is more likely to be a factor in admissions that occur less than a week after discharge than in those that occur later, a new study indicates.

Researchers performed a prospective cohort study at 10 U.S. academic medical centers to examine whether timing of readmission in relation to discharge was linked to preventability. Readmissions within seven days of discharge (early readmissions) were compared with those between 8 to 30 days of discharge (late readmissions). Two physician adjudicators at each study site used a structured survey instrument to assess each readmission and determine whether it was preventable. The study results were published online May 1 by Annals of Internal Medicine.

The study involved 822 adults readmitted to the general medicine service. Overall, 27.9% of readmissions were judged to be preventable, and of these, 36.2% were early and 23.0% were late (median risk difference, 13.0 percentage points; interquartile range, 5.5 to 26.4 percentage points). When the researchers looked at the ideal location for an intervention that would prevent a readmission, hospitals performed better for early versus late readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points; interquartile range, 17.9 to 31.8 percentage points), while outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points; interquartile range, 4.6 to 12.2 percentage points) and patients' homes (19.4% vs. 14.0%; median risk difference, 5.6 percentage points; interquartile range, −6.1 to 17.1 percentage points) performed better for late versus early readmissions.

The authors noted that the study did not include community hospitals or readmissions to nonstudy hospitals and that physician adjudicators were not blinded. However, they concluded that early readmissions were more likely to be preventable than late readmissions and were more likely to be caused by such factors as premature discharge and problems with physician decision making. Late readmissions, meanwhile, were more likely to be related to factors outside the hospital's direct control, such as inappropriate monitoring and management of symptoms after discharge.

“We believe it is time to change the model for patient outcomes after hospital discharge to one that recognizes shared accountability for readmissions along the entire spectrum of care,” the researchers wrote. “If this cannot be achieved in the short term, our findings suggest that a 7-day readmission window will more accurately capture preventable hospital admissions.”