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Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients.


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

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<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]

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