To Reduce Hospital Readmissions, Perhaps Focus on the Whole Patient and Not a Specific Condition

Stenting blocked coronary arteries at hospitals without the ability to perform emergency cardiac surgery appears save and effective. (Image: andipantz )

Research suggests that the way to reduce hospital readmissions is to treat the patient as a whole and not concentrate on reducing the risk of a recurrence of the condition that led to hospitalization in the first place. (Image: andipantz/ )

US Hospitals, which can face financial penalties for readmitting large numbers of patients within 30 days of discharging them, want to lower their 30-day readmission rates. And patients certainly don’t want such return visits, either. Research appearing today in BMJ suggests that hospitals can lower 30-day readmission rates by developing strategies that focus on the whole patient rather than concentrating on such a specific time period or diagnoses that have historically been associated with a higher percentage of readmissions.

The researchers reached this conclusion based on findings of a retrospective cohort study of Medicare beneficiaries who were readmitted in 2007 through 2009 within 30 days after hospital admission for heart failure, acute heart attack, or pneumonia. There were 320 003 readmissions within 30 days of 1.29 million admissions for heart failure among 4041 hospitals, 102 536 readmissions after 517 827 admissions for acute heart attack among 2378 hospitals, and 208 438 readmissions after 1.14 million admissions for pneumonia among 4283 hospitals.

About 21% of patients admitted for heart failure initially treated at high-performing hospitals were readmitted within 30 days compared with nearly 25% at average-performing hospitals and nearly 29% at low-performing hospitals. Among patients initially admitted for acute heart attack, about 16%, 20%, and 25% were readmitted at high-, average-, and low-performing hospitals, respectively. About 15%, 18%, and 22% of patients admitted for pneumonia were readmitted to high-, average-, and low-performing hospitals, respectively. High-performing hospitals were defined as those with a high probability of having a 30-day readmission rate lower than the national rate during the 3-year study period; low-performing hospitals were highly likely to have a rate that exceeded the national rate.

The researchers said high-performing hospitals appeared to achieve lower overall rates of readmission not by reducing readmissions for specific diagnoses or time periods such as 30 days after discharge, but rather through using general strategies and interventions that apply broadly across potential readmission diagnoses and not just those that led to the initial admissions and time periods within and beyond 30 days after discharge.

“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,” said Harlan Krumholz, MD, senior author and director of Yale School of Medicine’s Center for Outcomes Research in New Haven, Connecticut, in a release. “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 postdischarge period safer.”

Categories: Cardiovascular Disease/Myocardial Infarction, Cardiovascular Interventions, Medical Practice, Pneumonia