The key to reducing hospital admissions may be focusing on the whole patient, rather than a specific condition that caused the hospitalization in the first place, researchers say.
Checking back into the hospital within 30 days of discharge is not only bad news for patients. It’s also bad for hospitals, which now face financial penalties for high readmissions.
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For a new study published in the British Medical Journal, researchers found that top-performing hospitals—those with the lowest 30-day readmission rates—had fewer readmissions from all diagnoses and time periods after discharge than lower performing hospitals with higher readmissions.
“Our findings suggest 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,” says lead author Kumar Dharmarajan, a visiting scholar at the Center for Outcomes Research and Evaluation at Yale University School of Medicine and a cardiology fellow at Columbia University Medical Center.
Despite the increased national focus on reducing hospital readmissions, it has not been clear whether hospitals with the lowest readmission rates have been especially good at reducing readmissions from specific diagnoses and time periods after hospitalization, or have instead lowered readmissions more generally.
600,000 readmissions
To find out, he and colleagues studied over 4,000 hospitals in the United States caring for older patients hospitalized with heart attacks, heart failure, or pneumonia from 2007 through 2009. The authors examined over 600,000 readmissions occurring within 30 days of hospitalization.
Readmission diagnoses and timing were similar regardless of a hospital’s 30-day readmission rates. High performing hospitals had fewer readmissions across all diagnostic categories and time periods after discharge.
“Earlier data show that patients are readmitted for a broad range of conditions. We have found empirically that hospitals with the lowest readmission rates have reduced readmissions across the board,” Dharmarajan says.
“This study suggests that the path to excellence in readmission is a result of an approach that focuses on the patient as a whole rather than on what caused them to be admitted,” says Harlan Krumholz, professor of medicine and professor of investigative medicine and of public health.
“And this study adds emphasis to the idea that patients are susceptible to a wide range of conditions after a hospitalization—they are a highly vulnerable population and we need to focus intently on making the immediate post-discharge period safer.”
The National Heart, Lung, and Blood Institute funded the study.
Source: Yale University
