Preventing hospital readmissions may require broader strategy

Addressing readmission risk from a broader perspective rather than focusing on specific conditions or time periods may be more effective at lowering readmission rates, according to a study published online Nov. 20 in BMJ.

“Rates of readmission in the 30 days after an index admission for heart failure, acute myocardial infarction, or pneumonia remain high and variable across hospitals in the United States,” wrote the authors, led by Kumar Dharmarajan, MD, MBA, of Columbia University Medical Center in New York City.

To test whether hospitals with the lowest 30-day readmission rates had fewer readmissions for all diagnoses and post-discharge time frames, the researchers evaluated Medicare data for patients 65 and older with 30-day readmissions for heart failure, heart attack or pneumonia between 2007 and 2009. In addition to diagnoses, they looked at the readmission time frame and categorized hospitals’ 30-day risk standardized readmission rates based on public data as high-, average- or low-performing for each illness.

High-performing and low-performing hospitals had a 95 percent or greater probability of having a risk estimate less than or greater than the readmission rate average over the study period. Other hospitals were defined as average performers.

Readmissions within 30 days of discharge were most frequent for heart failure (320,003 of 1,291,211 admissions). Readmission distributions were similar across all performance categories for all three conditions, but high performers had fewer readmissions regardless of the condition. Average readmission time was 1.4 days longer for pneumonia in high-performing hospitals compared with low-performing hospitals. After adjusting for hospital variables that could affect readmission, such as teaching status, urban vs. rural location and ownership status, the findings were similar.

The authors acknowledged that among the study limitations were the exclusion of hospitals with fewer than 25 index admissions and the inclusion of planned readmissions for certain treatments such as chemotherapy.

Based on their analysis, however, they argued that readmission risk reduction strategies should not focus on specific illnesses or time frames.

“These findings suggest that lower readmission rates might best be achieved through use of general strategies and capacities that lower readmission risk globally rather than for specific diagnoses or time periods after admission,” they wrote.