more_vert
HOSPITAL readmission rates are “a legitimate concern” in Australia and deserve closer examination, according to a leading epidemiologist.
Professor David Ben-Tovim, director of the Flinders Medical Centre’s units for redesigning care and clinical epidemiology, said it was “very good practice” to understand why patients came back, to find ways of minimising readmission and to reduce the burden on hospitals.
Professor Ben-Tovim was responding to three ambitious studies published in JAMA last week as part of a themed issue on readmissions.
The US studies looked at the reasons for readmissions and ways to improve care transitions. The studies found that readmission rates were not necessarily a satisfactory measure of hospital performance given the wide range of variables that drive patients to seek care.
The first study, based on Medicare fee-for-service claims data for about 3 million hospitalisations, looked at readmission rates after hospitalisation for heart failure, acute myocardial infarction or pneumonia. (1)
The authors concluded that readmissions were frequent throughout the month after hospitalisation and resulted from a similar spectrum of readmission diagnoses “regardless of age, sex, race, or time after discharge”. Overall readmission rates were 24.8%, 19.9% and 18.3% for the three conditions respectively.
The second study of more than 5 million hospitalisations examined how emergency department (ED) visits and hospital readmissions contributed to overall use of acute care services within 30 days of discharge from acute care hospitals. (2)
The researchers found nearly 18% of hospitalisations resulted in at least one acute care encounter within the 30 days, and that nearly 40% of these encounters were patients treated in EDs and released.
The authors wrote that improving care transitions should focus not only on decreasing readmissions but also on ED visits.
The other study concentrated on paediatric readmissions and concluded that there was significant variability in readmission rates across conditions and hospitals. (3)
Professor Ben-Tovim said the studies were sophisticated attempts to try to discover the patient variables involved in readmission rates, and how hospitals could improve patient care.
“What all the studies showed is that it is not uncommon for patients to be readmitted within 30 days of their initial discharge. That is clearly a matter of concern for everybody — a legitimate source of concern”, he said.
Professor Debora Picone, chief executive officer of the Australian Commission on Safety and Quality in Health Care, agreed that more study on readmission rates in Australia was needed.
“There is no question that readmission rates here are too high”, Professor Picone said. “There are very big variations across regions and particularly between states.
“I don’t see readmission rates as a good indicator of hospital performance but I am a big fan of it as an indicator of how a hospital can improve, and the quality of patient care services”, she said.
Professor Ben-Tovim said that regardless of questions of hospital performance, there were good reasons to try to reproduce the US studies here.
“There is no question that the more complicated and fragmented transfer of care is, the more likely it is that the health care facility that never closes — the emergency department — will be reactivated.
“As the [second] study shows, in America at least, that represents a substantial burden of work.”
Professor Picone said the lack of national data on readmission rates in Australia should be rectified in the next 12 months.
“It is only in the last few years that we have concentrated on collecting that kind of data”, she said.
“It takes a while to make certain of the veracity of the data and we probably need 12 months more to work on the data quality to make sure that when [the information] is published — and it should be published on the MyHospitals website — that it makes sense to the public”, she said.
– Cate Swannell
1. JAMA 2013; 309: 355-363
2. JAMA 2013; 309: 364-371
3. JAMA 2013; 309: 372-380
Posted 29 January 2013
I’ve just had a dip back into public Psychiatry as a locum, and confirmed my conclusion, first drawn in private practice, that it would help if more time were spent in the first admission to get people properly stabilised before discharge so that less relapse would occur. (But quick turnover looks better in the raw statistics I suspect, and there is the lack of beds.) Sending people home on medication the GP can’t prescribe legally for their condition on the PBS doesn’t help ether.
Recently, Trappe S et al. J Appl Physiol 2013;114:3-10
showed elderly (>80yrs age)long-term endurance athletes had a functional level similar to sedentary 20-year-old young adults. In comparison a general population’s functional capacity was just above the cut-off functional capacity between dependence and independence. So might some components of this dilemma include preadmission physical standards, rest, the impact of the “illness” on physical capacity and the discharge physical capacity?
Perhaps one question may be: Does improving or high functional capacity, cardiorespiratory fitness and strength, buffer the elderly against the physiological decline imparted by acute health problems.
Another might be what are we doing about it?
As an elderly retired doctor I have become aware from personal experience and observation of my elderly peers that we take a long time to recover from major surgery and may never regain our previous level of health; I have reflected on seeing the reduced strength and increased disabiity of elderly friends who underwent major cardiovascular surgery to “improve their long term prognosis” that a more conservative approach to care may have been better for them.