Many readmissions not preventable, study says

Despite international efforts to reduce hospital readmission rates, a new Canadian study finds that readmission rates are not an accurate measure of quality and may not be prevented as patient safety advocates have long argued.

Oftentimes, patients are readmitted for urgent, unplanned reasons, researchers said. They concluded that those incidents unfairly may be deemed "avoidable" and should not be included as an absolute measure of care delivery. In fact, there are fewer actual avoidable readmissions that originally thought, according to their study published in yesterday's Canadian Medical Association Journal.

"Not all urgent readmissions are avoidable, despite the care that is provided," said lead study author Dr. Carl van Walraven, a clinical epidemiologist at the Ottawa Hospital Research Institute, in an Ottawa Citizen article. "This means that a lot of them are caused by a patient's condition, or other factors that are not treatable or modifiable."

Researchers looked at more than 4,800 patients at 11 Ontario hospitals. They found that 13.5 percent of the discharged patients were readmitted to the emergency department. Although previous studies found that eight in 10 of return hospital visits could have been prevented, the study found that only one in five return visits are actually preventable, according to the article. That means, 16 percent of those readmissions were deemed "avoidable" through the physician peer review process, according to a press release.

The study may confirm what critics have said about quality metrics not being a true measure of quality. It's isn't a surprise that hospitals, particularly, the low-scoring ones, dispute quality data, such as Hospital Compare, that posts readmission rates.

"The study basically acknowledges the fact that it's very difficult to define avoidable admissions," said van Walraven.

For more information:
- read the press release
- read the Ottawa Citizen article
- check out the full study (.pdf)

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