Regional rates of hospital readmission within 30 days are strongly correlated with the overall tendency to hospitalize patients for any reason in that region, according to a report in the Dec. 15 issue of the New England Journal of Medicine.
High rates of 30-day hospital readmission are seen as an indication that patients received poor transitional care at discharge and immediately thereafter. But rather than reflecting inadequate care, high readmission rates may simply reflect the customary tendency to hospitalize patients in any given geographic area, said Dr. Arnold M. Epstein of the department of health policy and management at the Harvard School of Public Health, Boston, and his associates.
The investigators examined the factors that correlated with readmission rates using information from a Medicare database on patients aged 65 years and older who were discharged with a diagnosis of heart failure or pneumonia during a recent 6-month period. The subjects were seen at 306 "hospital referral regions" (HRRs) across the country.
Data on hospitals’ discharge practices were obtained from a separate survey of different patients who were asked about their experiences at discharge from hospitals in the same HRRs. In addition, the probability that each study subject would require readmission was estimated based on more than 32 clinical and demographic factors listed in their medical records.
The study included 234,477 discharges with heart failure from 4,432 hospitals and 237,025 discharges with pneumonia from 4,497 hospitals in the 306 HRRs.
Readmission rates varied considerably among the hospitals studied. The single factor that explained most of this variation was not case mix, quality of discharge planning, patient traits, or hospital characteristics; rather, it was the overall rate of hospitalizations in the region, the investigators said (N. Engl. J. Med. 2011;365:2287-95).
"Although most interventions designed to reduce readmissions thus far have focused on better disease management and the coordination of care, our results underscore the importance of policy efforts directed at reducing the general incentives to use hospital services," they noted.
Regional patterns of care rather than patient traits or hospital characteristics may be the key to reducing readmissions. "We estimate that each year there are approximately 115,568 readmissions within 30 days after discharge among patients initially hospitalized for [heart failure] and 84,854 readmissions among those initially hospitalized for pneumonia.
"We found that if all-cause admission rates for the HRRs in the upper quintiles of hospital utilization were reduced to the rate in the lowest quintile, the readmission rate for [heart failure] would be reduced from 24.6% to 21.2%, eliminating approximately 16,166 (14.0%) of the readmissions for Medicare beneficiaries. For pneumonia, the readmission rate would be reduced from 17.9% to 15.5%, eliminating 11,434 (13.5%) of the readmissions," Dr. Epstein and his associates said.
This study was supported by the Commonwealth Fund. One of Dr. Epstein’s associates reported receiving a grant from the Robert Wood Johnson Foundation. No financial conflicts of interest were reported.