Low hospital readmission rates apply across diagnoses

ST LOUIS (MD Consult) - Hospitals with lower 30-day readmission rates have a lower number of readmissions across a wide range of diagnoses and throughout the post-discharge period, reports a study in the January 11, 2014, British Medical Journal. The researchers analyzed data on Medicare beneficiaries aged 65 or older who were readmitted within 30 days after admission for heart failure, acute myocardial infarction, or pneumonia from 2007 to 2009. Readmission diagnoses were classified using a modified version of the Centers for Medicare and Medicaid Services' condition categories, and the timing of readmission was classified by day since discharge. Based on 30-day risk-standardized readmission rates over the 3 years studied, hospitals were classified as having high, average, or low readmission performance for each condition. The range of readmission diagnoses and median times to readmission were compared for high-, average-, and low-performing hospitals. The lead author was Kumar Dharmarajan of Columbia University Medical Center. The analysis included about 320,000 readmissions after 1.3 million admissions for heart failure at 4,041 hospitals, 103,000 readmissions after 516,000 admissions for acute myocardial infarction at 2,378 hospitals, and 208,000 readmissions after 1.1 million admissions for pneumonia at 4,328 hospitals. For all 3 index conditions, the range of readmission diagnoses was similar at hospitals with high, average, and low readmission rates. For heart failure and acute myocardial infarction, median time to readmission was similar across the 3 hospital performance groups. For pneumonia, median time to readmission was 1.4 days longer among high-performing hospitals, compared to low-performing hospitals. The patterns were similar after adjustment for additional hospital factors potentially affecting readmission rates. Thirty-day readmission rates vary substantially among U.S. hospitals. There are few data on how hospital readmission rates are related to the diagnoses and timing of readmissions. This information could have implications for identifying the effective strategies followed by the best-performing hospitals. For the 3 index diagnoses studied, hospitals with low 30-day readmission rates have proportionately fewer readmissions, with similar readmission diagnoses and timing. The results may help to explain why studies evaluating "broad based and longitudinal" interventions for lowering readmissions have higher reported higher success rates, compared to "disease specific or time limited interventions."