Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients.
Ann Intern Med. 2018 May 01;:
Authors: Graham KL, Auerbach AD, Schnipper JL, Flanders SA, Kim CS, Robinson EJ, Ruhnke GW, Thomas LR, Kripalani S, Vasilevskis EE, Fletcher GS, Sehgal NJ, Lindenauer PK, Williams MV, Metlay JP, Davis RB, Yang J, Marcantonio ER, Herzig SJ
Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame.
Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.
Design: Prospective cohort study.
Setting: 10 academic medical centers in the United States.
Patients: 822 adults readmitted to a general medicine service.
Measurements: For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics.
Results: Overall, 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference, 13.0 percentage points [interquartile range, 5.5 to 26.4 percentage points]). Hospitals were identified as better locations for preventing early readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points [interquartile range, 17.9 to 31.8 percentage points]), whereas outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points [interquartile range, 4.6 to 12.2 percentage points]) and home (19.4% vs. 14.0%; median risk difference, 5.6 percentage points [interquartile range, -6.1 to 17.1 percentage points]) were better for preventing late readmissions.
Limitation: Physician adjudicators were not blinded to readmission timing, community hospitals were not included in the study, and readmissions to nonstudy hospitals were not included in the results.
Conclusion: 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.
Primary Funding Source: American Association of Medical Colleges.
PMID: 29710243 [PubMed - as supplied by publisher]