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Hospital readmissions arise from many causes

Tuesday January 22, 2013
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Among approximately 3 million Medicare patients hospitalized for heart failure, myocardial infarction or pneumonia, readmissions were frequent throughout the 30 days following the hospitalization, and resulted from a wide variety of diagnoses that often differed from the cause of the index hospitalization, according to a study.

In background information for the study, which appears in the Jan. 23/30 issue of the Journal of the American Medical Association, researchers noted that hospital readmissions "are common and can be a marker of poor healthcare quality and efficiency."

To lower readmissions rates, the researchers added, the Centers for Medicare & Medicaid Services has begun publicly reporting 30-day risk-standardized readmission rates for heart failure, acute MI and pneumonia with the endorsement of the National Quality Forum. The federal strategy aims to provide incentives to improve quality of care by reducing preventable readmissions.

"Critical to the development of effective programs to reduce readmission is an understanding of the diagnoses and timing associated with these events," the authors wrote. "Insights into the diversity and variation of readmission diagnoses can illustrate the potential benefits of general vs. disease-specific interventions in reducing the overall number of readmissions."

Kumar Dharmarajan, MD, MBA, of Columbia University Medical Center in New York City, and colleagues analyzed 2007-09 Medicare fee-for-service claims data to examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, MI or pneumonia, conditions that are primarily responsible for almost 15% of hospitalizations in older people and are the focus of public reporting efforts.

During the time period analyzed, the researchers identified 329,308 30-day readmissions after 1,330,157 hospitalizations for heart failure (24.8% readmitted), 108,992 30-day readmissions after 548,834 hospitalizations for acute MI (19.9% readmitted) and 214,239 30-day readmissions after 1,168,624 hospitalizations for pneumonia (18.3% readmitted).

Following hospitalization for heart failure and acute MI, readmission was most often because of heart failure (35.2% and 19.3% of readmissions, respectively). Following hospitalizations for pneumonia, readmission was most often for recurrent pneumonia (22.4%).

The researchers reported that 61% of 30-day readmissions for heart failure, 67.6% of those for acute MI and 62.6% of those for pneumonia occurred within 15 days following discharge. A significant number, more than 30% in each cohort, occurred between days 16 and 30.

The median times to readmission were 12 days for patients initially hospitalized with heart failure, 10 days for patients initially hospitalized with acute MI and 12 days for patients initially hospitalized with pneumonia. Neither readmission nor timing substantively varied by age, sex or race.

"The diagnoses associated with 30-day readmission are diverse and are not associated with patient demographic characteristics or time after discharge for older patients initially hospitalized with HF, acute MI or pneumonia," the authors wrote. "Although a high percentage of 30-day readmissions occurred relatively soon after hospitalization, readmissions remained frequent during days 16 through 30 after discharge regardless of patient age, sex or race.

"This heightened vulnerability of recently hospitalized patients to a broad spectrum of conditions throughout the postdischarge period favors a generalized approach to preventing readmissions that is broadly applicable across potential readmission diagnoses and effective for at least the full month after hospitalization. Strategies that are specific to particular diseases or periods may only address a fraction of patients at risk for rehospitalization."

The study is available at http://jama.jamanetwork.com/article.aspx?articleid=1558276#qundefined.


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