One in eight Medicare patients were readmitted to the hospital within 30 days of a surgical discharge in 2010, as were one in six patients within 30 days of a medical discharge, according to a study.
Both rates were virtually unchanged from 2008, according to the report, released Feb. 11 by the Robert Wood Johnson Foundation.
The highest regional rate for 30-day medical readmissions was 18.1% in Bronx, N.Y., compared with a low of 11.4% in Ogden, Utah. The national average was 15.9%.
The highest regional rate for 30-day surgical readmissions was 18.3% in the Bronx, compared with a low of 7.6% in Bend, Ore. The national average was 12.4%.
The findings are based on new data that includes readmission rates for states, hospital referral regions and more than 3,000 hospitals from the Dartmouth Atlas Project, which largely is funded by RWJF. The analysis shows the overall lack of improvement in readmissions extends back to 2004, the earliest year that the Dartmouth Atlas Project has studied, with the national rate for readmissions following a medical discharge remaining the same in 2010 as it was that year.
Many readmissions are avoidable and, as the report notes, can occur because of differences in patient health status; the quality of inpatient care, discharge planning and care coordination; the availability and effectiveness of local primary care; and the threshold for admission in the area. The Centers for Medicare & Medicaid Services began reductions in Medicare reimbursement last year for hospitals with high rates of readmissions.
“Although hospitals are a key venue of care, the one thing thats clear is that this is not just a hospital problem,” RWJF President and CEO Risa Lavizzo-Mourey, MD, said in a news release. “Patients, families, friends and the entire community have a role to play in reducing avoidable readmissions, and to succeed we need to face this problem together.”
The data show the chance of readmission after patients leave the hospital varies markedly across regions and hospitals and that overall readmission rates did not decline meaningfully from 2008 to 2010.
“While there are certainly pockets of improvement, as a nation, we have a long ways to go,” said David C. Goodman, MD, MS, co-principal investigator for the Dartmouth Atlas Project. “Variation in the quality of care between health systems is hard for patients and practicing physicians to see, but the differences are substantial. And many patients are readmitted simply because they live in a region where the hospital is used more frequently at the site of care.”
For example, there was marked variation in the percentage of Medicare patients readmitted to the hospital within 30 days of an initial medical discharge in 2010. Two other Utah regions, Provo (12.1%) and Salt Lake City (12.9%), also had relatively low rates. Readmission rates also were high in Detroit (17.8%) and Chicago (17.7%).
Thirty-day readmission rates following surgical discharge varied more than twofold. Regions with rates below 10% other than Bend, Ore., included Boise, Idaho (8.4%), Santa Barbara, Calif. (9%), Spokane, Wash. (9.5%) and Seattle (9.9%). Readmission rates following surgery were nearly twice as high not only in the Bronx, but in other regions in the New York City area, including White Plains (17.4%), East Long Island (16.3%) and Manhattan (16%).
The study excluded patients who had any acute care hospitalizations in the 90 days before the admission date used to calculate readmission rates. The definition used by CMS excludes acute care hospitalizations only in the 30 days prior to the admission date, so the rates differ slightly.
A second section of the report includes findings from 32 interviews conducted by the research firm PerryUndem in December and January in metropolitan Washington, D.C., New York City and Dallas to find out why people make so many return trips to the hospital and what is being done to improve their care. This storytelling project focused on patients, caregivers and healthcare providers.
The report is available to download at http://bit.ly/Y3Kgr7.
The report will be featured at a February 13 event in Washington, D.C. to celebrate promising practices for reducing avoidable readmissions. The event is part of RWJFs Care About Your Care initiative (www.rwjf.org/goto/yourcare), a month-long effort to focus attention on the national problem of avoidable readmissions, spotlight how hospitals and communities are working to improve care and help patients understand their roles.