Studies pinpoint likelihood of 30-day readmissions, identify prevention measures

Hospitals could have prevented more than a quarter of readmissions of discharged Medicare patients within 30 days, according to a study published in JAMA Internal Medicine by researchers at the University of California San Francisco (UCSF).

The study at 12 academic medical centers across the country found that 15 percent of readmissions were almost certainly preventable, and 12 percent were more likely than not preventable. Another 15 percent were about 50-50 on whether they were preventable, according to an announcement about the study findings. 

In addition, nearly a third of readmissions could have been avoided if emergency departments hadn't admitted patients who didn't need to be in the hospital, the lead researcher said.

Other factors in preventable readmissions included patients unable to keep follow-up appointments or unaware who to contact if problems arose; discharging patients too soon; and insufficient disease monitoring after discharge.

Actions that can reduce 30-day readmissions, according to the study announcement, include:

  • Better communication with patients
  • Improved communication between primary care and hospital doctors
  • Better assessment as to whether patients are ready for discharge
  • Improved post-discharge resources

Separate research released earlier this year found that most patients don't understand their post-discharge care plans because they're written for those with advanced reading skills, FierceHealthcare previously reported.

Another study published the same day as the UCSF study by JAMA Internal Medicine found that the HOSPITAL score accurately predicted which patients are at high-risk of a potentially avoidable 30-day readmission.

The score is compiled using these predictors (and contributors to the HOSPITAL acronym) at discharge:

  • Hemoglobin level
  • Discharge from an Oncology service
  • Sodium level
  • Procedure during the index admission
  • Index Type of admission (urgent)
  • Number of Admissions during the last 12 months
  • Length of stay

Patients identified by the score as being at high risk were four times more likely to be readmitted within 30 days than patients identified at low risk, according to an announcement from Brigham & Women's and Harvard Medical School, which conducted the research. A 30-day potentially avoidable readmission was predicted with a 72 percent probability.

"Overall, patients with a potentially avoidable readmission had an urgent or emergent index admission, were more frequently discharged from an oncology service, had a length of stay greater than five days, had more hospitalizations in the past year, were more likely to have had a procedure, and more often had a low hemoglobin or low sodium level at discharge," according to the announcement.

The physician who coined the term "post-hospital syndrome" to describe the window of vulnerability within 30 days of discharge has said that patients also are at greater risk of readmission because they can be exposed to secondary infections in the hospital, are thrown off their regular sleep, diet and medication routines, and can become stressed in the hospital, FierceHealthcare previously reported.

To learn more:
- here's the UCSF study
- read the UCSF announcement
- see the Brigham & Women's study
- check out the BWH announcement

 

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