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- Title
Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients.
- Authors
Graham, Kelly L.; Auerbach, Andrew D.; Schnipper, Jeffrey L.; Flanders, Scott A.; Kim, Christopher S.; Robinson, Edmondo J.; Ruhnke, Gregory W.; Thomas, Larissa R.; Kripalani, Sunil; Vasilevskis, Eduard E.; Fletcher, Grant S.; Sehgal, Neil J.; Lindenauer, Peter K.; Williams, Mark V.; Metlay, Joshua P.; Davis, Roger B.; Yang, Julius; Marcantonio, Edward R.; Herzig, Shoshana J.
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.<bold>Design: </bold>Prospective cohort study.<bold>Setting: </bold>10 academic medical centers in the United States.<bold>Patients: </bold>822 adults readmitted to a general medicine service.<bold>Measurements: </bold>For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics.<bold>Results: </bold>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.<bold>Limitation: </bold>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.<bold>Conclusion: </bold>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.<bold>Primary Funding Source: </bold>Association of American Medical Colleges.
- Subjects
UNITED States; PATIENT readmissions; HOSPITAL care; MEDICAL centers; HOSPITAL admission &; discharge; OUTPATIENT medical care; HOME care services
- Publication
Annals of Internal Medicine, 2018, Vol 168, Issue 11, p766
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M17-1724