Readmissions past 7 days may be out of hospitals' control, study finds

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Most hospital readmissions beyond seven days are attributable to factors beyond a hospital's control, suggests new findings from a study published in Health Affairs.

For the study, researchers examined hospital discharge records for nearly 7 million Medicare patients treated at 910 hospitals located across Arizona, California, Florida and New York. Researchers focused their analysis on three conditions: acute myocardial infarction, heart failure and pneumonia.

Robust statistical analysis revealed limited variation between hospitals regarding 30-day readmissions across all conditions with variations ranging from 0.8 percent for surgery to 1.1 percent for pneumonia. The analysis also displayed higher variations (3.2 percent readmission variation for pneumonia patients on the first day following discharge) between hospitals within the first week post-discharge, indicating that this may be a more accurate measure of readmissions associated with hospital care.

Researchers also found that many readmissions at 30 days and beyond could often be linked with factors attributable to the communities the hospitals served. CMS's current risk-standardized readmission models adjust for patient age, sex and clinical characteristics, but not for community influences.

"If the goal of current public policy is to encourage hospitals to assume responsibility for post-discharge adherence and primary care follow-up, then penalties assessed for readmissions within 30 days or longer periods might align appropriately. However, if the goal is empowering patients and families to make healthcare choices informed by true differences in hospital performance, then a readmission interval of seven days or fewer might be more accurate and equitable," concluded the study's authors.

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