Hospital Readmissions: Necessary Evil or Preventable Target For Quality Improvement
Erin G Brown*, Debra Burgess*, Richard J Bold
UC Davis, Sacramento, CA
The decision to penalize hospitals for readmissions is compelling healthcare systems to develop processes to minimize readmissions. Research focused on identifying preventable readmissions is critical to achieve these goals.
We performed a retrospective review of the University HealthSystem Consortium (UHC; 237 hospitals) database for all cancer patients hospitalized from 1/2010 to 9/2013. Main outcome measures were 7, 14, and 30-day readmission rates, and readmission diagnoses. Hospital and disease characteristics were evaluated to determine potential relationships with readmission.
2,517,886 patients were hospitalized for cancer treatment. Readmission rates at 7, 14, and 30 days post-discharge were 2.4%, 4.0%, and 6.1%. Despite concern that premature hospital discharge may be associated with higher readmission rates, initial length of stay did not correlate with readmission rates (Figure 1a). Furthermore, high volume centers did not have a lower readmission rate (Figure 1b). Factors associated with higher readmission rates include: discharge from a surgical service, site of malignancy, emergency vs. elective primary admission. Evaluating institutional data (N=1639 patients) demonstrated the most common readmission diagnoses were infectious causes (53.4%), thromboembolic events (9.7%), nausea/vomiting/dehydration (7.4%), and pain (7.4%).
A significant number of patients, following hospitalization for cancer-related therapy, are re-admitted with potentially preventable conditions such as nausea, vomiting, dehydration and pain. While some post-discharge readmissions are unavoidable, reducing preventable readmissions will be critical in the face of reimbursement policy changes.
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