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Preventability of early vs. late readmissions in an academic medical center.
PLoS One. 2017;12(6):e0178718
Authors: Graham KL, Dike O, Doctoroff L, Jupiter M, Vanka A, Davis RB, Marcantonio ER
Abstract
BACKGROUND: It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.
OBJECTIVE: Compare preventability of hospital readmissions, between an early period [0-7 days post-discharge] and a late period [8-30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.
DESIGN, SETTING, PATIENTS: 120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010.
MEASURES: Sum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.
RESULTS: Readmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1-6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].
CONCLUSIONS: Readmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.
PMID: 28622384 [PubMed - indexed for MEDLINE]