A recent study conducted by the Harvard School of Public Health (HSPH) suggests that high rates of hospital readmission in different regions in the US may be more affected by the overall rate of hospitalization in that area.
The study, published in the December 15 issue of the New England Journal of Medicine, challenges the current ideas that high readmission rates are caused by the severity of the patient’s condition or problems in the quality of patient care both during the hospital stay and after discharge.
The researchers identified all Medicare beneficiaries ages 65 and older who had been discharged from a hospital from January 1, 2001 to June 30, 2008 with a principal diagnosis of congestive heart failure or pneumonia. The patients were then assigned to a hospital referral region (HRR) based on their ZIP code.
The researchers calculated the readmission rates occurring 30 days, 60 days and 90 days after a patient’s discharge. In addition, the overall hospitalization rates, presence of coexisting conditions, quality of discharge planning and number hospital beds and primary care physicians in the HRRs were all examined.
The results showed that readmission rates among regions ranked from 11% to 32% for patients with congestive heart failure and from 8% to 27% for those with pneumonia. Overall hospital admission rates played the biggest role in readmission rates, accounting for 16% to 24% of the variation in cases of congestive heart failure and 11% to 20% in pneumonia cases.
“This is a very important observation that has been largely unrecognized in the literature or by policy makers,” study lead author Arnold Epstein, John H. Foster Professor of Health Policy and Management and chair of the Department of Health Policy and Management at HSPH, stated in a press release. “Hospitals may have limited ability to reduce readmissions. The responsibility for readmissions lies with the entire delivery system. Meaningful progress may require incentives directed at that level and a change in culture.
The current efforts to reduce the high costs of readmission focus on improving transitional care. However, the researchers suggest that programs directed at shared savings from lower utilization of hospital services, such as accountable care organizations, might be more successful in reducing readmissions.