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October 6, 2016

After 7 days, readmissions are mostly beyond hospitals' control, study finds

Daily Briefing

    Although readmission rates are typically measured over a 30-day post-discharge timeframe, hospitals have little control over readmissions beyond seven to 10 days, according to a study published Tuesday in Health Affairs.

    Researchers examined data on more than 6.7 million patients across 910 hospitals in Arizona, California, Florida, and New York. Specifically, the researchers looked at patients 65 years or older discharged from any non-federal hospital after suffering from three conditions: heart attacks, heart failure, and pneumonia. In addition, they analyzed patients who fit five hospital-wide unplanned readmission cohorts: surgery and gynecology, medicine, cardiorespiratory, neurology, and cardiovascular.

    Study findings

    The researchers found that the variation in readmissions rates between hospitals after accounting for patient factors "was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days."

    According to the researchers, their findings indicate that most readmissions after seven-days post-discharge result from factors outside of a hospital's control, such as community and household-level influences.

    In a blog post for Roll Call, study co-authors David Chin and Patrick Romano, "The greatest opportunity to discern differences in the quality of hospitals occurred during the first seven days following the hospital stay. During these seven days, the hospital quality signal dissipates quickly and reaches a minimum by the 10th day."

    Based on the findings, researchers said the 30-day window is too long to accurately capture safety problems that can be attributed to hospital care.

    And the researchers noted that even over shorter timeframes, "less than about 3 percent of a patient's readmission risk comes from differences in quality between hospitals." They also pointed to research that casting doubt on the link between readmission rates and quality of care, including a study that found higher readmission rates were actually associated with lower mortality rates in some instances.

    There's a 'simple' way to reduce readmissions, study suggests


    The study authors recommended that the 30-day time period for measuring readmissions "be shortened and better tailored to the actual time course of preventable complications after each conditions or procedure."

    Further, they wrote that "readmission rates should be regarded more as measures of resource use ... and less as measures of hospital quality." As such, they argued that readmissions should not bear so much weight in hospital quality rankings, including CMS' five-star ratings.

    "Readmissions reflect many things that happen to patients beyond the hospital walls," they said, including the quality of post-acute providers. "A more successful and sustainable approach to improving quality while reducing spending will require that hospital readmissions be considered within a broader context" (Chin/Romano, Roll Call, 10/4; Parry, Medscape, 10/4).

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