Literature Review: Readmissions and how geographical location of the hospitals affects the rate of readmissions

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Literature Review Readmissions and how
geographical location of the hospitals affects
the rate of readmissions

• -Shubhshankar

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What are Readmissions?
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What are Readmissions?

• CMS defines readmission as an admission to a
  hospital 30 days within the previous discharge.
  Patient transferred to another hospital are not
  counted under readmission 1.

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Why is it a problem?
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Is readmission rate indicator of quality of
Health Care?
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Is readmission rate indicator of quality of
Health Care?
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Reasons for Readmission-Higher Propensity to
get readmitted
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Reasons for Readmission.
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Reasons for Readmission.
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Detailed review Geographical location of
hospitals6.

• Boston 4.5 beds per thousand people.
• New Haven 2.9 beds per thousand.

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Division into cohorts

• Five cohorts- myocardial infarction, stroke,
  gastrointestinal bleeding, curative surgery for
  lung, colon etc.

• Rate of admission for these illness are similar
  as physicians agree on the need to hospitalize.

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Results

• Readmission rates in Boston were 1.64 times the
  readmission rates in New Haven.

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Results

• Higher readmission rates were not related to
  length of stay.
• index admission 14.8 vs 13.5 days
• readmission 11.3 vs 11.2 days

The mortality rate was similar at both places
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Explanations?

• Severity of illness?

• Nursing home care vs inpatient care?

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Results

• Association between availability of hospital beds
  and overall discharge rate.

Possible explanation- threshold of availability
of beds plays a role in clinical decision making.
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Solutions
Identify population with high propensity to get
readmitted

• Weekly home visits or phone calls to monitor
  progress of the patient.

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Solutions
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Solutions
Follow up appointment with the patients
physician.
Complete discharge summaries within 24 hours
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Solutions
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Questions?

• References -
• 1 Reducing hospital readmissions. By Jenny
  Minott
• 2 Catlin, A. et al. National Health Spending
  in 2006 A Year of Change for Prescription
  Drugs, Health Affairs, January/February 2008,
  Vol. 27, No. 1, pp. 14-29.
• 3 Medicare Payment Advisory Commission. 2007.
  Report to the Congress Promoting Greater
  Efficiency in Medicare. Washington, DC Medicare
  Payment Advisory Commission, p. 103.
• 4 Can readmission rates be used as an outcome
  indicator? Ruairidh Milne, Aileen Clarke
• 5 Benbassat, J. and M. Taragin. Hospital
  Readmissions as a Measure of Quality of Health
  Care, Archives of Internal Medicine, Vol. 160,
  No. 8, 2000, pp. 1074-81.
•  6 Hospital readmission rates for cohorts of
  medicare beneficiaries in Boston and New Haven
  by E. S. Fisher, J. E. Wennberg, T. A.
  Stukel, S. M. Sharp