Hospital readmissions
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Epidemiology
Among Medicare patients in the United States receiving care in a fee-for-service setting during 2003-2004, 19.6% were rehospitalized within 30 days.[1]
Causes
In a study of Medicare patients in the United States, most of the variation in rates of readmission are due to characteristics of patients.[2] A much smaller degree of variation is due to characteristics of hospitals or health care providers.[2]
A systematic review found that approximately 25% of readmissions are avoidable; however, rates varied widely among individual studies included within the review.[3]
Costs
Prediction
A number of methods have been developed to predict which patients will be readmitted.[4]
Two or more hospitalizations within a year is simple predictor of readmission.[5] A study of adult patients in the University of Pennsylvania Health System found that ≥ 2 inpatient admissions in the past 12 months had a sensitivity and specificity of 39% and 84%, respectively, for predicting readmission. In populations similar to those in this study which had a prevalence of hospital readmission of 15%, the probabilities of hospital readmission among patients with and without ≥ 2 inpatient admissions in the past 12 months were 30.0% and 11.0%, respectively.[5] Click here to estimate predictive values in populations with different rates of readmission. A second study reported sensitivity and specificity of 25% and 78%, respectively.[6]
Prevention
A meta-analysis of 42 randomized controlled trials found “interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care.”[7] This review also reported that more recent trials showed less impact. Accordingly, a more trial found of a virtual ward, found a reduction in admissions of 4%, but this was not statistically significant.[8]
Regarding medication reconciliations, a meta-analysis by the Cochrane Collaboration found no clear benefit.[9]
Regarding telephone calls to patients after discharge, detailed, scripted phone calls may be effective.[10][11]
References
- ↑ Jencks SF, Williams MV, Coleman EA (2009). "Rehospitalizations among patients in the Medicare fee-for-service program". N Engl J Med. 360 (14): 1418–28. doi:10.1056/NEJMsa0803563. PMID 19339721.
- ↑ 2.0 2.1 Singh S, Lin YL, Kuo YF, Nattinger AB, Goodwin JS (2014). "Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics". J Gen Intern Med. 29 (4): 572–8. doi:10.1007/s11606-013-2723-7. PMC 3965757. PMID 24307260.
- ↑ van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ (2011). "Proportion of hospital readmissions deemed avoidable: a systematic review". CMAJ. 183 (7): E391–402. doi:10.1503/cmaj.101860. PMC 3080556. PMID 21444623.
- ↑ Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M; et al. (2011). "Risk prediction models for hospital readmission: a systematic review". JAMA. 306 (15): 1688–98. doi:10.1001/jama.2011.1515. PMC 3603349. PMID 22009101.
- ↑ 5.0 5.1 Baillie CA, VanZandbergen C, Tait G, Hanish A, Leas B, French B; et al. (2013). "The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission". J Hosp Med. 8 (12): 689–95. doi:10.1002/jhm.2106. PMID 24227707.
- ↑ Hasan O, Meltzer DO, Shaykevich SA, Bell CM, Kaboli PJ, Auerbach AD; et al. (2010). "Hospital readmission in general medicine patients: a prediction model". J Gen Intern Med. 25 (3): 211–9. doi:10.1007/s11606-009-1196-1. PMC 2839332. PMID 20013068.
- ↑ Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K; et al. (2014). "Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials". JAMA Intern Med. 174 (7): 1095–107. doi:10.1001/jamainternmed.2014.1608. PMID 24820131.
- ↑ Dhalla IA, O'Brien T, Morra D, Thorpe KE, Wong BM, Mehta R; et al. (2014). "Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial". JAMA. 312 (13): 1305–12. doi:10.1001/jama.2014.11492. PMID 25268437.
- ↑ Christensen M, Lundh A (2013). "Medication review in hospitalised patients to reduce morbidity and mortality". Cochrane Database Syst Rev. 2: CD008986. doi:10.1002/14651858.CD008986.pub2. PMID 23450593.
- ↑ Oduyebo I, Lehmann CU, Pollack CE, Durkin N, Miller JD, Mandell S; et al. (2013). "Association of self-reported hospital discharge handoffs with 30-day readmissions". JAMA Intern Med. 173 (8): 624–9. doi:10.1001/jamainternmed.2013.3746. PMC 3692004. PMID 23529278.
- ↑ Melton LD, Foreman C, Scott E, McGinnis M, Cousins M (2012). "Prioritized post-discharge telephonic outreach reduces hospital readmissions for select high-risk patients". Am J Manag Care. 18 (12): 838–44. PMID 23286612.