The use of 30-day readmissions as a measure of care quality has come under fire from providers, and now a new study suggests that it's more useful to look at a window of about a week after discharge.
Researchers found that a five-to-seven day window can better identify readmissions directly related to hospital action, according to a study published in Health Affairs. The researchers analyzed unplanned inpatient readmissions for six million patients at 910 U.S. hospitals in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. They found that variation between hospitals on readmission rates was higher in the first few days after discharge, reaching a peak at day seven.
The findings, according to the study, suggest that readmissions that occur after the first week post-discharge are more likely to be caused by factors beyond a hospital’s control. Provider organizations like the American Hospital Association have called into question 30-day readmission data as a way for the Centers for Medicare & Medicaid Services to measure care quality and punish hospitals, FierceHealthcare previously reported, saying it may not account for outside risk factors like socioeconomic issues.
“If the goal of current public policy is to encourage hospitals to assume responsibility for post-discharge adherence and primary care follow-up, then penalties assessed for readmissions within 30 days or longer periods might align appropriately,” the researchers conclude. “However, if the goal is empowering patients and families to make healthcare choices informed by true differences in hospital performance, then a readmission interval of seven days or fewer might be more accurate and equitable.”
David Chin, Ph.D., a postdoctoral scholar in health policy at the University of California, Davis, and Patrick Romano, M.D., a professor of general medicine and pediatrics at UC Davis, write in a commentary on the findings, published in Roll Call, that there are three potential solutions to move from away from penalizing hospitals for excessive 30-day readmissions:
- Shorten the 30-day window or design a measure that allows hospitals to catch complications that may occur after discharge
- Apply readmission rate measures to resource use and not care quality
- Use readmissions as part of a measure of overall avoidable hospital use