Hospital readmission rates may affect adverse event risk in patients admitted with pneumonia

Patients with pneumonia who were admitted to hospitals with high readmission rates had an elevated risk for in-hospital adverse events, according to a study published in JAMA Network Open.

The cross-sectional study included 46,047 patients with pneumonia (median age, 71 years; 52% women) at 2,590 U.S. hospitals who were discharged from July 2010 to December 2019, with data in the Medicare Patient Safety Monitoring System. Researchers linked patient-level adverse event data to hospital-level pneumonia-specific all-cause readmissions data from CMS. Hospital performance during readmission was assessed using the risk-standardized 30-day all-cause readmission rate, and researchers examined the association between adverse events and readmissions.

“Some people have questioned whether readmission rates may not be related to hospital quality — we sought to determine if there was a link between hospital performance on readmissions with the risk of these in-hospital adverse events,” Harlan M. Krumholz, MD, SM, the Harold H. Hines, Jr. Professor of Medicine in the department of internal medicine and director of Yale New Haven Hospital Center for Outcomes Research and Evaluation, told Healio.

The median hospital-specific risk-standardized readmission rate was 17%, the occurrence rate of adverse events was 2.6% and the number of adverse events per 1,000 discharges was 157.3.

Each increase of one interquartile range in the readmission rate was associated with a 13% higher risk for adverse events (adjusted OR = 1.13; 95% CI, 1.08-1.17) and five more adverse events per 1,000 discharges at patient and hospital levels.

“Patients admitted to hospitals with high readmission rates are at higher risk for in-hospital adverse events that might signal safety issues,” Krumholz told Healio. “The implication is that factors that lead to readmission and factors associated with a higher risk of in-hospital adverse events may be similar — and these safety issues could even be contributing to higher readmission rates.”

Krumholz said further research should aim to identify key common quality domains that increase the risk of in-hospital adverse events and readmissions.

“We need to focus on improving quality, and this study suggests that there could be dividends by improving patient safety and decreasing readmission rates,” Krumholz said.

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Harlan M. Krumholz, MD, SM, can be reached at harlan.krumholz@yale.edu.