Readmission rate as an indicator of hospital performance: The case of Spain

Jiménez-Puente, Alberto; García‐Alegría, Javier; Gómez-Aracena, Jorge; Hidalgo-Rojas, Luis; Lorenzo-Nogueiras, Luisa; Perea-Milla-López, Emilio; Navajas, Joaquín Fernández-Crehuet

doi:10.1017/s0266462304001230

Cited by 28 publications

(33 citation statements)

References 26 publications

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“…Some studies found that most readmissions were unavoidable and conclude that readmission rates should not be used as a valid indicator of QOC 7,18 .…”

Section: Discussionmentioning

confidence: 99%

Early Readmissions to the Department of Medicine as a Screening Tool for Monitoring Quality of Care Problems

Balla

Malnick²,

Schattner³

2008

Medicine

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With growing awareness of medical fallibility, researchers need to develop tools to identify and study medical mistakes. We examined the utility of hospital readmissions for this purpose in a prospective case-control study in a large academic medical center in Israel. All patients with nonelective readmissions to 2 departments of medicine within 30 days of discharge were interviewed, and their medical records were carefully examined with emphasis on the index admission. Patient data were compared to data for age- and sex-matched controls (n = 140) who were not readmitted. Medical records of readmitted and control patients were blindly evaluated by 2 senior clinicians who independently identified potential quality of care (QOC) problems during the index admission. Inhospital and late mortality was determined 6 months after discharge.Over a period of 3 months there were 1988 urgent admissions; 1913 discharges and subsequently 271 unplanned readmissions occurred (14.1% of discharges). Readmissions occurred an average of 10 days after discharge, and readmitted patients were sicker than controls (mean, 4.3 vs. 3.3 diagnoses per patient), although their length of stay was similarly short (3.4 +/- 2.8 d). Analysis of all readmissions revealed QOC problems in 90/271 (33%) of readmissions, 4.5% of hospitalizations. All were deemed preventable. Interobserver agreement was good (83%, kappa = 0.67). Among matched controls, only 8/140 admissions revealed QOC problems (6%, p < 0.001) (k = 0.77). The preventable readmissions mostly involved a vascular event or congestive heart failure; they occurred within a mean of 10 +/- 8 days of the index admission, and their inpatient mortality was 6.7% vs. 1.7% among readmissions that had no QOC problems (odds ratio, 4.1; 95% confidence interval, 1.0-16.7). The main pitfalls identified during the index admission included incomplete workup (33%), too short hospital stay (31%), inappropriate medication (44%), diagnostic error (16%), and disregarding a significant laboratory result (12%). In many patients more than 1 pitfall was identified (mean, 1.5 per patient). Risk factors for preventable readmission include older age and living in an institution (p < 0.05). Almost two-thirds of the readmitted patients with QOC problems were discharged after spending 2 days or fewer at the hospital. In conclusion, unplanned readmissions within 30 days of discharge are frequent, more prevalent in sicker patients, and possibly associated with increased mortality. In a third of readmitted patients a QOC problem can be identified, and these problems are preventable. Thus, readmission may be used as a screening tool for potential QOC problems in the department of medicine. Routine monitoring of all readmissions may provide a simple cost-effective means of identifying and addressing medical mistakes.

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“…Some studies found that most readmissions were unavoidable and conclude that readmission rates should not be used as a valid indicator of QOC 7,18 .…”

Section: Discussionmentioning

confidence: 99%

Early Readmissions to the Department of Medicine as a Screening Tool for Monitoring Quality of Care Problems

Balla

Malnick²,

Schattner³

2008

Medicine

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“…A researcher and an experienced physician concurrently used a set of criteria derived from previously published research (Table 1) [7], in order to assign the readmission into one of the two categories. An agreement was reached by a discussion between the two professionals in the case of discordant opinions.…”

Section: Methodsmentioning

confidence: 99%

Hospital Readmission Prevalence and Analysis of Those Potentially Avoidable in Southern Italy

et al. 2012

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BackgroundOne quality indicator of hospital care, which can be used to judge the process of care, is the prevalence of hospital readmission because it reflects the impact of hospital care on the patient’s condition after discharge. The purposes of the study were to measure the prevalence of hospital readmissions, to identify possible factors that influence such readmission and to measure the prevalence of readmissions potentially avoidable in Italy.MethodsA sample of 2289 medical records of patients aged 18 and over admitted for medical or surgical illness at one 502-bed community non-teaching hospital were randomly selected.ResultsA total of 2252 patients were included in the final analysis, equaling a response rate of 98.4%. The overall hospital readmission prevalence within 30 days of discharge was 10.2%. Multivariate logistic regression analysis revealed that the proportion of patients readmitted within 30 days of discharge significantly increased regardless of Charlson et al. comorbidity score, among unemployed or retired patients, and in patients in general surgery. A total of 43.7% hospital readmissions were judged to be potentially avoidable. Multivariate logistic regression analysis showed that potentially avoidable readmissions were significantly higher in general surgery, in patients referred to hospital by an emergency department physician, and in those with a shortened time between discharge and readmission.ConclusionAdditional research on intervention or bundle of interventions applicable to acute inpatient populations that aim to reduce potentially avoidable readmissions is strongly needed, and health care providers are urged to implement evidence-based programs for more cost-effective delivery of health care.

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“…Clarke 10 Gautam 14 Halfon 23 Kirk 31 Shalchi 38 Williams 9 Ruiz 34 Oddone 16 Phelan 37 Halfon 30 Kelly 13 Kwok 19 MacDowell 7 Maurer 29 Vinson 11 Graham 5 Haines-Wood 15 Jimenez-Puente 28 McInness 8 Stanley 35 Madigan 22 Balla 32 Courtney 26 Frankl 12 Levy 21 McKay 17 Miles 20 Munshi 24 Popplewell 6 Sutton 25 Witherington 36 Experton 18 Friedman 27 Goldfield (Table 4). Error bars = 95% confidence intervals.…”

Section: % Readmissions Deemed Avoidablementioning

confidence: 99%

Proportion of hospital readmissions deemed avoidable: a systematic review

Walraven¹,

Bennett²,

Jennings³

et al. 2011

Canadian Medical Association Journal

608

493

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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,"

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Readmission rate as an indicator of hospital performance: The case of Spain

Abstract: Most readmissions in our hospital were unavoidable. Thus, readmission rate might not be considered a valid indicator of quality of care.

Cited by 28 publications

References 26 publications

Early Readmissions to the Department of Medicine as a Screening Tool for Monitoring Quality of Care Problems

Early Readmissions to the Department of Medicine as a Screening Tool for Monitoring Quality of Care Problems

Hospital Readmission Prevalence and Analysis of Those Potentially Avoidable in Southern Italy

Proportion of hospital readmissions deemed avoidable: a systematic review

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