Ontology highlight
ABSTRACT: Background
Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame.Objective
To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.Design
Prospective cohort study.Setting
10 academic medical centers in the United States.Patients
822 adults readmitted to a general medicine service.Measurements
For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics.Results
Overall, 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference, 13.0 percentage points [interquartile range, 5.5 to 26.4 percentage points]). Hospitals were identified as better locations for preventing early readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points [interquartile range, 17.9 to 31.8 percentage points]), whereas outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points [interquartile range, 4.6 to 12.2 percentage points]) and home (19.4% vs. 14.0%; median risk difference, 5.6 percentage points [interquartile range, -6.1 to 17.1 percentage points]) were better for preventing late readmissions.Limitation
Physician adjudicators were not blinded to readmission timing, community hospitals were not included in the study, and readmissions to nonstudy hospitals were not included in the results.Conclusion
Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.Primary funding source
Association of American Medical Colleges.
SUBMITTER: Graham KL
PROVIDER: S-EPMC6247894 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
Graham Kelly L KL Auerbach Andrew D AD Schnipper Jeffrey L JL Flanders Scott A SA Kim Christopher S CS Robinson Edmondo J EJ Ruhnke Gregory W GW Thomas Larissa R LR Kripalani Sunil S Vasilevskis Eduard E EE Fletcher Grant S GS Sehgal Neil J NJ Lindenauer Peter K PK Williams Mark V MV Metlay Joshua P JP Davis Roger B RB Yang Julius J Marcantonio Edward R ER Herzig Shoshana J SJ
Annals of internal medicine 20180501 11
<h4>Background</h4>Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame.<h4>Objective</h4>To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>10 academic medical centers in the United States.<h ...[more]