30-day readmission metric needs to be revamped

Although CMS finalized its Hospital Readmissions Reduction Program policy in 2012 to classify "readmission" as a patient's re-hospitalization within 30 days of discharge, monitoring when readmissions occur within that time could offer significant insights for healthcare systems.

 

New research conducted by researchers at Beth Israel Deaconess Medical Center in Boston, Mass., and published in the Annals of Internal Medicine suggests that including a shorter benchmark within that 30-day window could be more effective in signaling inpatient quality of care and unnecessary healthcare utilization. 

 

"Our research found that risk factors for readmission evolved during the first 30 days following hospital discharge," Kelly L. Graham, MD, lead author and a physician in the division of general medicine and primary care at BIDMC and an instructor in internal medicine at Harvard Medical School, said in a statement.  "Readmissions in the first week were more highly associated with factors related to the initial hospitalization than later readmissions. These findings suggest that the standard 30-day metric does not accurately reflect hospitals' accountability for readmissions."

 

Metrics for early readmissions, defined in the study as zero to seven days post discharge, offer more exact markers for the acute illness managed during a patient's initial hospitalization, according to the study. Researchers reported a patient's chronic illness burden as being more significant in predicting late readmissions — between eight and 30 days following initial discharge. 

 

Here are five important points noted by the authors. 

 

•Discharge between 8 a.m. and 12:59 p.m. was associated with reduced likelihood of early readmission; this is attributed to additional time in the early part of the day to access pharmacies and social support.

•Lower health literacy was associated with readmission at any time within the 30-day window

•Patients without supplemented Medicare or Medicaid were more likely to be readmitted 8-30 days post discharge.

•Research reflects that hospitals strictly following evidence-based care standards do not necessarily have the lowest readmission rates.

•Readmission rates do not serve as a benchmark to inpatient mortality.