Kelly L Graham1, Andrew D Auerbach2, Jeffrey L Schnipper3, Scott A Flanders4, Christopher S Kim5, Edmondo J Robinson6, Gregory W Ruhnke7, Larissa R Thomas8, Sunil Kripalani9, Eduard E Vasilevskis10, Grant S Fletcher11, Neil J Sehgal12, Peter K Lindenauer13, Mark V Williams14, Joshua P Metlay15, Roger B Davis1, Julius Yang1, Edward R Marcantonio1, Shoshana J Herzig1. 1. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (K.L.G., R.B.D., J.Y., E.R.M., S.J.H.). 2. University of California, San Francisco, San Francisco, California (A.D.A.). 3. Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (J.L.S.). 4. University of Michigan Medical School, Ann Arbor, Michigan (S.A.F.). 5. University of Washington, Seattle, Washington (C.S.K.). 6. Value Institute, Christiana Care Health System, Wilmington, Delaware (E.J.R.). 7. University of Chicago, Chicago, Illinois (G.W.R.). 8. University of California, San Francisco, at Zuckerberg San Francisco General Hospital, San Francisco, California (L.R.T.). 9. Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee (S.K.). 10. Center for Quality Aging at Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee (E.E.V.). 11. Harborview Medical Center, University of Washington, Seattle, Washington (G.S.F.). 12. University of Maryland School of Public Health, College Park, Maryland (N.J.S.). 13. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts (P.K.L.). 14. Center for Health Services Research, University of Kentucky, Lexington, Kentucky (M.V.W.). 15. Massachusetts General Hospital, Boston, Massachusetts (J.P.M.).
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. Primary Funding Source: Association of American Medical Colleges.
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. Primary Funding Source: Association of American Medical Colleges.
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