Proportion of hospital readmissions deemed avoidable: a systematic review

Abstract

In most instances, unplanned readmissions to hospital indicate bad health outcomes for patients. Sometimes they are due to a medical error or the provision of suboptimal patient care. Other times, they are unavoidable because they are due to the development of new conditions or the deterioration of refractory, severe chronic conditions.Hospital readmissions are frequently used to gauge patient care. Many organizations use them as a metric for institutional or regional quality of care.1 The widespread public reporting of hospital readmissions and their use in considerations for funding implicitly suggest a belief that readmissions indicate the quality of care provided by particular physicians and institutions.The validity of hospital readmissions as an indicator of quality of care depends on the extent that readmissions are avoidable. As the proportion of readmissions deemed to be avoidable decreases, the effort and expense required to avoid one readmission will increase. This de crease in avoidable admissions will also dilute the relation between the overall readmission rate and quality of care. Therefore, it is important to know the proportion of hospital readmissions that are avoidable.We conducted a systematic review of studies that measured the proportion of readmissions that were avoidable. We examined how such readmissions were measured and estimated their prevalence. Methods Literature searchWe consulted a local information scientist to develop a search strategy to identify studies that measured the proportion of readmissions deemed avoidable (Appendix 1, available at www .cmaj .ca /cgi /content /full /cmaj .101860 /DC1). We applied this strategy to search the MEDLINE and EMBASE databases for English-language papers published from 1966 to July 2010. Fulltext versions of citations were re trieved for complete review if they specified that hospital readmissions were counted; and the title or abstract used any term(s) indicating that re admissions were classified as avoidable (or "preventable,"

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study

“…If our findings are corroborated, they may suggest potential customization of interventions to improve transitions of care based on residential status. Finally, while the proportion of readmissions that is truly preventable is controversial, 26 the data demonstrating the high rate of preventability of post-discharge AEs are more consistent across studies, thus justifying the need for the effective implementation of interventions to improve patient safety during transitions of care.…”

Rehospitalization for Heart Failure

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Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey

“…[2][3][4][5] In addition, debate continues on the preventability of hospital readmissions, with a systematic review estimating that as few as 27 % of readmissions are truly preventable. 6 The high rate of hospital readmissions and uncertain effects of readmission reduction programs may, in part, stem from incomplete understanding of the reasons for readmission or Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3764-5) contains supplementary material, which is available to authorized users. strategies to prevent readmission among physicians-key leaders and architects of institutional change surrounding care transitions and initiators of specific services targeted for individual patients.…”