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 25 May 2018

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News

Hospital quality contributes in part to readmission rates independent of factors involving patients

This week's issue of the New England Journal of Medicine investigates readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year.

News image

To isolate hospital effects on risk-standardized hospital-readmission rates, Dr Harlan Krumholz examined readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year.

The researchers divided the Centers for Medicare and Medicaid Services hospital-wide readmission measure cohort from 2014 through 2015 into 2 random samples.

All the patients in the cohort were Medicare recipients who were at least 65 years of age.

The team used the first sample to calculate the risk-standardized readmission rate within 30 days for each hospital, and classified hospitals into performance quartiles, with a lower readmission rate indicating better performance.

The median risk-standardized readmission rate was 16%
New England Journal of Medicine

The study sample included patients who had two admissions for similar diagnoses at different hospitals that occurred more than 1 month and less than 1 year apart, and the team compared the observed readmission rates among patients who had been admitted to hospitals in different performance quartiles.

In the performance-classification sample, the median risk-standardized readmission rate was 16%.

The research team sample included 37,508 patients who had 2 admissions for similar diagnoses at a total of 4272 different hospitals.

The observed readmission rate was consistently higher among patients admitted to hospitals in a worse-performing quartile than among those admitted to hospitals in a better-performing quartile.

However, the team noted that the only significant difference was observed when the patients were admitted to hospitals in which one was in the best-performing quartile and the other was in the worst-performing quartile.

Dr Krumholz's team comments, "When the same patients were admitted with similar diagnoses to hospitals in the best-performing quartile as compared with the worst-performing quartile of hospital readmission performance, there was a significant difference in rates of readmission within 30 days."

"The findings suggest that hospital quality contributes in part to readmission rates independent of factors involving patients."

NEJM 2017; 377:1055-1064
19 September 2017

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