Getting patients out of the hospital quickly may seem like a great way to save money. According to a Journal of the American Medical Association (JAMA) study released Wednesday though, while shorter stays have cut costs, they also lead to more unplanned readmissions. In the end, total costs may actually be higher with the shorter stays because of overall increased readmissions.
The study used Medicare data to look at features of heart failure patients from 1993-94 to 2005-06. Along with the decreased length of stay and increased readmission rates, the study found a decline in in-hospital deaths among patients. However, more patients died after discharge.
Between 1993 and 2006, the average length of stay for elderly heart failure patients decreased to 2.5 days from 6.3 days; inpatient death rates were nearly cut in half to 4.3 percent; 30-day mortality decreased from 12.8 to 10.7 percent; and death after discharge increased from 4.3 percent to 6.4 percent. Other notable figures from the report include a decline in patients going directly home or to home care, and an increase--to 19.9 percent--in the number of patients going to skilled nursing facilities. Readmission rates increased from just over 17 percent to over 20 percent during the study period.
Harlan Krumholz, MD, the lead author of the study and a professor of medicine at Yale, noted that the mixed results of the study show that in some areas, heart failure care is clearly improving. But in other ways--particularly knowing when to discharge a patient or how to monitor a discharged patient to ensure fewer readmissions and post-discharge deaths--care has to improve. He noted specifically that hospitals need better incentives to keep an eye on patients after they get out of the hospital. It might be as easy as ensuring that patients have a way to pick up their medications and take them as prescribed.