Abstract
Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame. Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability. Design: Prospective cohort study. Setting: 10 academic medical centers in the United States. Patients: 822 adults readmitted to a general medicine service. Measurements: For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics. Results: Overall, 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference, 13.0 percentage points [interquartile range, 5.5 to 26.4 percentage points]). Hospitals were identified as better locations for preventing early readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points [interquartile range, 17.9 to 31.8 percentage points]), whereas outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points [interquartile range, 4.6 to 12.2 percentage points]) and home (19.4% vs. 14.0%; median risk difference, 5.6 percentage points [interquartile range,-6.1 to 17.1 percentage points]) were better for preventing late readmissions. Limitation: Physician adjudicators were not blinded to readmission timing, community hospitals were not included in the study, and readmissions to nonstudy hospitals were not included in the results. Conclusion: Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.
| Original language | English |
|---|---|
| Pages (from-to) | 766-774 |
| Number of pages | 9 |
| Journal | Annals of Internal Medicine |
| Volume | 168 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jun 5 2018 |
Bibliographical note
Funding Information:Financial Support: By an unrestricted research grant from the Association of American Medical Colleges. This work was done with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center, through award UL1 TR001102 from the National Institutes of Health and financial contributions from Harvard University and its affiliated academic health care centers. Dr. Graham is funded by the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Herzig is funded by grant K23AG042459 from the National Institute on Aging. Dr. Mar-cantonio was supported in part by grants R01AG030618 and K24AG035075 from the National Institute on Aging. Dr. Vasi-levskis was supported by National Institute on Aging award K23AG040157, the Veterans Affairs Clinical Research Center of Excellence, and the Geriatric Research Education and Clinical Center.
Funding Information:
Disclosures: Dr. Schnipper reports grants from Mallinckrodt Pharmaceuticals outside the submitted work. Dr. Flanders has given expert testimony and reports grants from Blue Cross Blue Shield of Michigan and the Agency for Healthcare Research and Quality and personal fees from Wiley Publishing outside the submitted work. Dr. Kim reports grants from the Association of American Medical Colleges during the conduct of the study and personal fees from ZS Pharma and Actavis Pharma outside the submitted work. Dr. Kripalani reports personal fees from Verustat and SAI Interactive and equity from Bioscape Digital outside the submitted work. Dr. Lindenauer receives support from the Center for Outcomes Research & Evaluation at Yale New Haven Health System, under contract from the Centers for Medicare & Medicaid Services, to develop hospital outcome measures for pneumonia and chronic obstructive pulmonary disease. Dr. Williams reports consul- tancy for Telligen Technical Expert Panel and Medical College of Wisconsin; grants from the Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, and National Center for Advancing Translational Sciences; payment for lectures from Northwestern University and the Society of Hospital Medicine; royalties from Elsevier; and payment for development of educational presentations from Vizient outside the submitted work. Dr. Davis reports payments for service on the American Heart Association's editorial board outside the submitted work. Dr. Herzig reports grants from the National Institute on Aging during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje /ConflictOfInterestForms.do?msNum=M17-1724.
Funding Information:
By an unrestricted research grant from the Association of American Medical Colleges. This work was done with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center, through award UL1 TR001102 from the National Institutes of Health and financial contributions from Harvard University and its affiliated academic health care centers. Dr. Graham is funded by the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Herzig is funded by grant K23AG042459 from the National Institute on Aging. Dr. Marcantonio was supported in part by grants R01AG030618 and K24AG035075 from the National Institute on Aging. Dr. Vasilevskis was supported by National Institute on Aging award K23AG040157, the Veterans Affairs Clinical Research Center of Excellence, and the Geriatric Research Education and Clinical Center.
Publisher Copyright:
© 2018 American College of Physicians.
ASJC Scopus subject areas
- Internal Medicine