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Early hospital readmissions more preventable than late readmissions

Readmissions to the hospital within 7 days of discharge tend to be more preventable than those between 8 and 30 days after discharge, according to Annals of Internal Medicine.

“Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame,” Kelly L. Graham, MD, MPH, from Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote.

Graham and colleagues performed a prospective cohort study to compare the preventability of early (within 7 days of discharge) and late (between 8 and 30 days after discharge) hospital readmissions. The researchers used a structured survey instrument to measure readmission preventability and other characteristics.

Data indicated that more early readmissions were preventable than late readmissions (36.2% vs. 23%; median risk difference, 13 percentage points). The ideal location for preventing early readmissions were hospitals (47.2% vs. 25.5%; median risk difference, 22.8 percentage points), while outpatient clinics (15.2% vs. 6.6%; median risk difference, 10 percentage points) and homes (19.4% vs. 14%; median risk difference, 5.6 percentage points) were better locations for preventing late readmissions.

Early readmissions were mostly caused by factors that the hospital is accountable for, including problems with physician decision making and premature discharge, whereas late readmissions were mostly caused by factors that the hospital has less accountability over, including appropriate monitoring and managing of symptoms after discharge and preferences for end-of-life, according to the researchers.

“We believe it is time to change the model for patient outcomes after hospital discharge to one that recognizes shared accountability for readmissions along the entire spectrum of care,” Graham and colleagues concluded. “If this cannot be achieved in the short term, our findings suggest that a 7-day readmission window will more accurately capture preventable hospital readmissions.” – by Alaina Tedesco

Disclosure: Graham reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.