Commentary published in JAMA Surgery calls into question the effectiveness of 30-day readmissions data as an indicator of care quality--and as a threshold the Centers for Medicare & Medicaid Services use to penalize hospitals.
The commentary notes that a recent study, also published in JAMA Surgery, found that most readmissions are not caused by hospitals, but instead by other factors like drug use and mental illness. The study examined data from more than 170 readmissions and found that only 18 percent were linked to a recurrent infection at the surgical site or a case of preventable harm. Close to one-third were instead patients who were injectible drug users or were unable to access needed social support services.
The commentary, penned by Alexander C. Schwed, M.D., a research resident at the Harbor-UCLA Medical Center’s Department of Surgery, and Christian de Virgilio, M.D., the Harbor-UCLA surgery department chair, notes that this is just the most recent article that suggests that the 30-day window is not a good metric to use for penalizing hospitals or for indicating surgical quality. Schwed and Virgilio note that previous findings suggest that there are clerical issues in identifying readmissions--databases are often inaccurate when detailing the causes of readmission, they write.
Some clinicians have also argued that readmitting patients is a sound practice to decrease mortality, according to the commentary, so hospitals should not be financially penalized for providing needed care.
It falls then to researchers, the authors write, to develop better metrics for assessing surgical quality, one that is more “reliably calculable and clinically useful. Perhaps with yet another article questioning the role of 30-day readmissions, we should focus our attention on finding better markers of surgical quality,” they write.
- read the commentary