The sicker a patient is upon admission, the more likely he'll return to hospital, study suggests

Much has been said and written about the critical role that discharge planning and care coordination play in preventing rehospitalizations. But a new study by California's Office of Statewide Health Planning and Development shows that patients who are "sicker" upon their initial patient stay can also be frequent flier risks.

Nationally, about one-fifth of U.S. Medicare patients are readmitted within 30 days of a hospitalization, costing tax payers an additional $17.4 billion. In California, a whopping 36 percent of hospitalized patients were readmitted in 2005. Those readmitted the most--more than half required at least one readmission within one year--tended to suffer from heart failure, emphysema or kidney failure. They were also more likely to be Medicare or Medi-Cal beneficiaries, reported researcher Mary Tran and colleagues.

In addition, they "had a longer length of stay at their first visit, were more likely to have a medical rather than a surgical condition, and were more likely to be admitted via the emergency room than the patients with just a single visit," Tran wrote.

"This has serious implications for overall health outcomes and the cost of healthcare for all Americans," Patrick Johnston, president of the California Association of Health Plans told the Sacramento Bee.

The cost for Californians thus far has been $31 billion for Medicare charges--good enough for half of all of the state's Medicare charges--and $10 billion for Medi-Cal charges--49 percent of that total. Readmissions also accounted for $11 billion in charges to private insurance companies, and $1 billion in charges to patients who paid out of pocket.

Sutter Health, one of Northern California's major providers, is bucking the trend. Last year it launched a "Transitions of Care" program, in which registered nurses call recently discharged patients to check up on their status. According to the Bee, Sutter's readmission rate for Medicare patients after one month of discharge stands at between 7 and 9 percent; the national readmission rate after the first month of discharge is currently 18 percent.

To learn more:
- here's the OSHPD's study
- read the Sacramento Bee article

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