Are All Readmissions Bad Readmissions?

Gorodeski, Eiran Z.; Starling, Randall C.; Blackstone, Eugene H.

doi:10.1056/nejmc1001882

Cited by 190 publications

(168 citation statements)

References 2 publications

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“…Readmission is still considered to be avoidable and led to the establishment of a penalty system for readmission within 30 days in the USA [24][25][26]. However, the prediction of readmission is still poor and most of the published data fail to show any improvement of readmission rates in COPD as a result of financial penalties [26,27].…”

Section: Discussionmentioning

confidence: 99%

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

et al. 2015

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Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes. @ERSpublications Hospital-admitted COPD exacerbation needs better risk stratification: spirometry and gas analysis improve outcomes http://ow.ly/RTbdk

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Section: Discussionmentioning

confidence: 99%

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

et al. 2015

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“…Higher rates of readmission after hospitalization for exacerbations of some chronic diseases, such as CHF, are associated with lower, rather than higher, mortality (20,21).…”

Section: Lack Of Evidence That Decreasing Readmissions Results In Impmentioning

confidence: 99%

Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions

Feemster

2014

Am J Respir Crit Care Med

102

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In October 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) will expand its Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). Under the new policy, hospitals with high risk-adjusted, 30-day all-cause unplanned readmission rates after an index hospitalization for a COPD exacerbation will be penalized with reduced reimbursement for the treatment of Medicare beneficiaries. In this perspective, we review the history of the HRRP, including the recent addition of COPD to the policy. We critically assess the use of 30-day all-cause COPD readmissions as an accountability measure, discussing potential benefits and then highlighting the substantial drawbacks and potential unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD. We conclude by emphasizing the need to place the 30-day COPD readmission measure in the context of a reconceived model for postdischarge quality and review several frameworks that could help guide this process.

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“…The effect of early visit on readmission and mortality, although more pronounced in the first week (days [8][9][10][11][12][13][14][15], persisted during the entire follow-up period. Table 4 displays the results of prespecified subgroup analyses.…”

Section: Propensity-score-matched Cohortmentioning

confidence: 99%

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N 5 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] 51.10; 95% confidence interval [CI] 5 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR 5 0.60; 95% CI 5 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. Conclusions: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (HEPATOLOGY 2016;64:569-581) C irrhosis is a common and costly condition.Most patients with cirrhosis require frequent hospitalizations. Approximately 20% of patients with cirrhosis who have been hospitalized get readmitted to the hospital within the first 30 days after discharge, with substantial implications for outcomes and cost of care. (1)(2)(3) Hospital readmission is a problem that is not unique to patients with cirrhosis. (4-6) Readmission rates and consequently readmission reduction programs have been a major focus of recent quality improvement initiatives across many chronic conditions. In 2012, the Centers for Medicare and Medicaid Services (CMS) began to invoke penalties for readmissions of patients who have been discharged after hospitalizations for congestive heart failure (CHF), pneumonia, and acute myocardial infarction. (7) Recently, the CMS also started to reimburse for early transitional care as a

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Are All Readmissions Bad Readmissions?

Cited by 190 publications

References 2 publications

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

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