Recent efforts to reduce hospital readmissions for common medical conditions have not led to an increase in death rates. In fact, they actually may have led to a decrease in mortality rates, a new study finds.
The research, published this week in JAMA, looked at data on Medicare patients who were hospitalized for heart attacks, heart failure or pneumonia between 2008 and 2014 to determine whether efforts to reduce readmissions led to the unintended consequence of increased mortality rates. Yale researchers looked at more than 6 million hospitalizations from 5,057 hospitals over 7 years and didn't find evidence that the decline in hospital readmissions led to a greater chance in death for those patients.
In fact, they found a small but positive correlation between the reduced readmissions and reduced mortality rates for the three conditions. “We can say that readmission reductions did not result in increased mortality. If anything, they may have decreased mortality,” said lead author Kumar Dharmarajan, M.D., assistant professor of medicine, in the study announcement.
The results suggest that the link between reduced rates for readmissions and mortality may be due to the steps hospitals take to improve care coordination after discharge. Those strategies include better preparing patients and families for discharge, more timely follow-up and improved communication with outpatient providers.
Dharmarajan said the research team also found that the link between reduced readmissions and reduced mortality was even stronger at 90 days compared to 30 days after hospital discharge.
And senior author Harlan Krumholz, M.D, said the study validates that the national focus on readmissions improved outcomes without causing unintended harm. “Thousands and thousands of readmissions are being avoided every year without any evidence of people being harmed—that is a victory of improving the quality of care,” he said.
In an accompanying editorial in JAMA, Karen E. Joynt Maddox, M.D., of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health said the findings indicate that it’s important hospitals continue to use these post-discharge strategies to help patients transition safely from hospital to home.
However, she said the study doesn’t address the possibility that all the attention given to reducing readmission has actually taken priority over reducing mortality rates, which could lead to slowing improvements in mortality. “Has a 'floor' for mortality been reached, such that further improvement is infeasible,” she wondered. “Or have attention and resources been directed away from innovations focused on reducing mortality, and in doing so slowed potential, additional progress? It is impossible to know with current data, particularly given the lack of a natural control group for the HRRP [Hospital Readmissions Reduction Program], but such issues warrant investigation.”