Preventability of early versus late hospital readmissions in a national cohort of general medicine patients

Kelly L. Graham, Andrew D. Auerbach, Jeffrey L. Schnipper, Scott A. Flanders, Christopher S. Kim, Edmondo J. Robinson, Gregory W. Ruhnke, Larissa R. Thomas, Sunil Kripalani, Eduard E. Vasilevskis, Grant S. Fletcher, Neil J. Sehgal, Peter K. Lindenauer, Mark V. Williams, Joshua P. Metlay, Roger B. Davis, Julius Yang, Edward R. Marcantonio, Shoshana J. Herzig

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame. Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability. Design: Prospective cohort study. Setting: 10 academic medical centers in the United States. Patients: 822 adults readmitted to a general medicine service. Measurements: For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics. Results: Overall, 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference, 13.0 percentage points [interquartile range, 5.5 to 26.4 percentage points]). Hospitals were identified as better locations for preventing early readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points [interquartile range, 17.9 to 31.8 percentage points]), whereas outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points [interquartile range, 4.6 to 12.2 percentage points]) and home (19.4% vs. 14.0%; median risk difference, 5.6 percentage points [interquartile range,-6.1 to 17.1 percentage points]) were better for preventing late readmissions. Limitation: Physician adjudicators were not blinded to readmission timing, community hospitals were not included in the study, and readmissions to nonstudy hospitals were not included in the results. Conclusion: Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.

Original languageEnglish
Pages (from-to)766-774
Number of pages9
JournalAnnals of internal medicine
Volume168
Issue number11
DOIs
StatePublished - Jun 5 2018

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