Source of readmissions: hospital admissions, not discharge planning

Hospitals in areas that have high admission rates also have a high propensity for readmission rates, according to a study published today in the New England Journal of Medicine.

Researchers at Boston's Harvard School of Public Health found that high readmission rates in certain regions of the country don't necessarily have to do with the severity of the patients' conditions or quality of care, but rather, the overall use of hospital services. Researchers looked at readmission rates for discharged patients with congestive heart failure and pneumonia across different regions. The biggest factor in variations between readmission rates, they found, was overall hospital admission rates.

"This is a very important observation that has been largely unrecognized in the literature or by policy makers," lead study author Arnold Epstein, professor and chair of the department of health policy and management at the Harvard School of Public Health, said in a press release yesterday. "Hospitals may have limited ability to reduce readmissions. The responsibility for readmissions lies with the entire delivery system. Meaningful progress may require incentives directed at that level and a change in culture."

Epstein and other researchers based the study on what they think is a weak connection between discharge planning and readmission rates, reports Cardiovascular Business. In light of reimbursement penalties for high readmission rates, hospitals have placed increased emphasis on improving the discharge process in hopes of cutting down on repeat hospitalizations--even going as far as calling it an "unfunded mandate," as New York's Mt. Sinai Hospital Administrator Claudia Colgan described it in a Kaiser Health News and NPR article. Supporters of transitional care have praised improvements in discharge planning under the assumption that it can, in fact, reduce readmission rates. However, the study notes that high readmission rates have more to do with the overuse of inpatient hospital services, according to HealthDay.

"This is about more than just how we discharge patients and follow-up, but about what happens to patients before they get admitted to hospitals," Dr. Bradley Sherman, chairman of the department of medicine at Glen Cove (N.Y.) Hospital, commented on the study. "I think the interesting part of this article is there is so much effort put on the discharge process, but this falls in the gap. Not a lot of people are looking at the other side of this, how the admission process affects readmission rates."

To learn more:
- read the press release
- here's the study abstract
- read the Cardiovascular Business article
- here's the Kaiser Health News and NPR article
- read the HealthDay article
- check out the Consumer Reports article

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