Hospitals that exhibited better adherence to discharge measures did not have lower readmission rates.
Preventing hospital readmissions presents an opportunity to improve healthcare quality and lower costs. Although the Centers for Medicare and Medicaid Services (CMS) have launched a national effort to report hospital performance on discharge planning, we know little about whether discharge planning translates to fewer bounce-back admissions.
Using congestive heart failure (CHF) as a benchmark, researchers accessed the CMS Hospital Quality Alliance database for information on CHF patients who were discharged from U.S. hospitals during 2007. Hospital performance was determined by:
• Chart-based discharge measure: whether CHF patients received adequate discharge instructions (composite of activity level and diet instructions, discharge medications, follow-up appointments, weight monitoring, and what to do if symptoms worsened)
• Patient-reported measure: patient satisfaction with discharge planning (for CHF recurrence or pneumonia)
The association between performance on these measures and readmission rates for CHF and pneumonia were measured.
A total of 2222 hospitals conveyed performance data on both chart-based and patient-reported discharge measures. No association was found between the two performance measures. Readmission rates for CHF across healthcare regions varied considerably (ranging from 13% in Ogden, Utah, to 37% in Oxford, Mississippi). Hospitals in the highest quartile of performance for CHF had 30-day readmission rates that were similar to those of hospitals in the lowest quartile (23.7% and 23.5%). A modest association was found between hospital performance on patient-reported measures and readmission rates.
Comment: In this study, better performance on hospital-documented discharge planning did not result in fewer 30-day readmissions. The results call into question whether public reporting will have any meaningful effect on lowering readmission rates. To have a real effect on hospital readmissions, multidisciplinary, systematic, and collaborative approaches will be necessary among inpatient and outpatient physicians, nurses, case managers, pharmacists, and (obviously) patients, as detailed in a 2009 study (JW Hosp Med Feb 2 2009). The wide disparity in readmissions across healthcare regions is eye opening and highlights the need for substantial improvement.
— Neil H. Winawer, MD, FHM
Published in Journal Watch Hospital Medicine February 12, 2010
Download our FREE Residential Care Community Guide
