Measuring readmission rates.

Abstract

Milne deal with the issue of using readmission rates as an outcome indicatorfor hospital care. Thefirst paper assesses thefeasibility ofmeasuring readmission ratesfrom routinely collected Korner data in a study of three districts in North East Thames region and the second, based on a study in one district, whether readmissions may be judged as avoidable or unavoidable. The third article examines the validity of using readmission rates as an outcome indicator, and the authors conclude that such an approach is misleading and should be avoided.

A Method for Determining an Emergency Readmission Time Window for Better Patient Management

“…For each specialty, the distribution of time between successive admissions exhibited a lognormal or exponential shape with approximately 32% of admissions occurring within 28 days after discharge. A similar pattern was found by Chambers et al [2], where time between successive admissions was showed to have an early peak (0-6 days), and then gradually levelled off after 28 days. However in both cases, the justification for the choice of 28 days relied solely on visual inspection of the histograms, therefore, it could result in an inaccurate estimation.…”

“…This approach, which takes a process point of view, can be shown [8] to be equivalent to the patient group argument presented in Section 2.1. In particular, the pdf of the mixture distribution (1) can be expressed by in terms of rates as p = q 10 − q 20 q 10 + q 12 − q 20 (2) and f 1 (x) and f 2 (x) are exponential density functions with parameters λ 1 = q 10 + q 12 and λ 2 = q 20 respectively. Therefore, the optimal cut-off time x * is computed by…”

“…In their effort to graphically determine a time window for emergency readmission, Sibbritt [11] and Chambers et al [2] recognised implicitly the existence of a change in the risk of readmission. That is the risk for readmission is high soon after a hospital discharge and the risk is substantially reduced after a period of time in the community.…”

Reingreso hospitalario en Medicina Interna

“…Otros factores son dependientes del tipo de enfermedad (8,21,24,25), siendo en general la tasa de reingreso más baja cuando la enfermedad es de tratamiento quirúrgico, de la gravedad del proceso clínico (34) y del seguimiento del enfermo (35). La tasa de reingreso es más alta en ancianos, particularmente en el anciano frágil (32) y la insuficiencia cardiaca uno de los problemas médicos con índi-ce de reingreso más alto (35,37).…”

“…Paradójicamente a lo que parece esperable, el efecto de la estancia media en ingresos previos, o no tiene influencia (24), o a mayor estancia mayor índice de reingreso (8).…”