BMJ: How top hospitals keep down readmission rates

Treat the "whole" patient, not just their condition, researchers say

Hospitals can reduce readmission rates by focusing on the whole patient rather than concentrating on the specific problem that resulted in their hospitalization, according to a new study in BMJ.

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For the study, Yale School of Medicine researchers examined data on Medicare beneficiaries who were readmitted between 2007 and 2009 after being treated for heart failure, acute heart attack, or pneumonia. Overall, the research included over 600,000 readmissions that occurred within 30 days of discharge at more than 4,000 hospitals nationwide.

Researchers defined high-performing hospitals as those with 30-day readmission rates below the national average, while low-performing hospitals were those with readmission rate that exceeded the average. Using these standards, the study found that:

  • About 21% of patients admitted to top high-performing hospitals for heart failure were readmitted within 30 days, compared with nearly 25% at average-performing hospitals and nearly 29% at low-performing hospitals;
  • About 16% of patients admitted to high-performing hospitals for acute heart attack were readmitted, compared with nearly 20% at average-performing hospitals and nearly 25% at low-performing hospitals; and
  • About 15% of patients admitted to high-performing hospitals for pneumonia were readmitted, compared with 18% at average-performing hospitals and 22% at low-performing hospitals.

According to lead study author Kumar Dharmarajan, the data show "that hospitals with the lowest readmission rates have reduced readmissions across the board," suggesting that "hospitals may best achieve low rates of readmission by employing strategies that lower readmission risk globally rather than for specific diagnoses or time periods after hospitalization" (Infection Control Today, 11/20; Mitka, "news@JAMA," JAMA, 11/20).

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