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One quarter of hospital readmissions potentially preventable

Recent findings published in JAMA Internal Medicine suggested that 26.9% of general medicine patient readmissions are potentially preventable. Also, the most common factors that contributed to preventable readmissions were premature discharge, ED decision making, inability to keep appointments after discharge, and patient lack of awareness of whom to call after discharge.

“The Affordable Care Act required the Department of Health and Human Services to establish a program to reduce what has been dubbed a ‘revolving door of rehospitalizations’,” Andrew D. Auerbach, MD, MPH, in the division of hospital medicine at the University of California, San Francisco, told Healio Internal Medicine. “Effective October 2012, 1% of every Medicare payment was deducted for a hospital that was determined to have excessive readmissions. Unfortunately, few data exist to guide us in determining how many readmissions are preventable, and in those cases, how they might have been prevented.”

Andrew D. Auerbach

To determine the preventability of readmissions, the researchers conducted an observational study of 1,000 general medicine patients, with a median age of 55 years, readmitted within 30 days of discharge at 12 U.S. medical centers between 2012 and 2013. For their analysis, the researchers surveyed patients and physicians, reviewed documentation, and performed a case review.

The researchers found that 269 of the 1000 readmissions were potentially preventable (26.9%). They found that the factors most strongly associated with potential preventability were ED decision making (aOR = 9.13; 95% CI, 5.23-15.95), failure to relay important information to outpatient health care professionals (aOR = 4.19; 95% CI, 2.17-8.09), premature discharge (aOR = 3.88; 95% CI, 2.44-6.17), and lack of discussions about care goals among patients with serious illnesses (aOR = 3.84; 95% CI, 1.39-10.64). They found that the most common factors associated with potential preventability were ED decision making (9%; 95% CI, 7.1-10.3), premature discharge (8.7%; 95% CI, 5.8-11.3), inability to keep appointments after discharge (8.3%; 95% CI, 4.1-12.0), and patient lack of awareness of whom to contact after discharge (6.2%; 95% CI, 3.5-8.7).

Because causality cannot be determined, eliminating these factors will not surely eliminate readmissions, the researchers wrote.

“Hospitals need to work with outpatient providers to improve communication and jointly come up with comprehensive programs to keep patients safe after discharge,” Auerbach said. “This requires investment, but it’s a better alternative than paying penalties.”

Disclosure: The researchers declare no relevant financial disclosures.