Curbing patient readmissions a matter of timing for hospitals, outpatient clinics

Although preventing unplanned readmissions is a major goal for hospitals, the preventability of readmissions changes over time, a study published in Annals of Internal Medicine found. Hospitals can often prevent readmissions within the first week of discharge, but readmissions that happen later often relate to patients' lack of access to outpatient clinics.

"Patients discharged from a hospital are usually recovering from a serious medical condition as well as managing other chronic medical conditions, and they often encounter new logistical challenges adapting to this recovery period," said study author Kelly Graham, MD. "Hospitals and outpatient clinics must work together more seamlessly to ensure that patients are equipped to manage these challenges at home."

Five things to know:

1. The researchers analyzed information on 822 general medicine patients readmitted to 10 U.S. academic medical centers. They found about 36 percent of early readmissions compared to 23 percent of late readmissions were preventable.

2. The study identified hospitals as better facilities for preventing early readmissions and found outpatient clinics and patients' homes were better for preventing late readmissions.

3. Readmissions in the early period were likely due to premature discharge and issues with physician decision-making related to diagnosis and management during patients' initial hospital stay, the study found. Factors the hospital has less direct control over likely led to later readmissions, including symptom management by primary care clinicians and end-of-life issues.

4. These findings suggest readmissions in the week after discharge are more preventable and more likely to be caused by factors the hospital has direct control over than readmissions later in the 30-day window. 

5. Interventions to improve outcomes after hospital discharge should engage the ambulatory care system, paying close attention to improving primary care access, Dr. Graham said. "We should also be careful not to put too much focus on reducing length of stay in the hospital, which may be a driver of premature discharge and early readmissions."

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