Predictors of the need for readmission to the hospital following discharge change throughout the first 30 days and may require different prevention strategies, according to the results of a study published in the June 2, 2015, issue of Annals of Internal Medicine. The study, which evaluated 13,334 admissions between January 2009 and December 2010 at a single academic medical center, found that early readmissions were associated with markers of acute illness burden (e.g., length of hospital stay, need for a rapid response team), markers of chronic illness burden (e.g., receiving a medication indicating organ failure), and social determinants of health (e.g., barriers to learning). The data indicated that late readmissions were associated with markers of chronic illness burden (e.g., receiving a medication indicating organ failure or hemodialysis) and social determinants of health (e.g., barriers to learning, having unsupplemented Medicare or Medicaid). The researchers note that early readmissions were less likely to occur if a patient was discharged between 8:00 a.m. and 12:59 p.m. In another study related to readmissions published in the same issue of Annals, the researchers used data from the Healthcare Cost and Utilization Project databases for six states to describe variation in emergency department (ED) revisit rates by diagnosis and the associated costs. They found that within three days of an index ED visit, 8.2% of the patients required a revisit and that 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis (skin infections had the highest rate at 23.1%) and by state. In Florida, which was the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days equaled 118% of the total index ED visit costs for all patients (with or without a revisit), indicating that among ED patients in Florida, more resources are spent on revisits than on index ED visits.

HRC Recommends: The Centers for Medicare and Medicaid Services imposes reimbursement penalties for high rates of readmission for heart failure, acute myocardial infarction, pneumonia, acute exacerbation of chronic obstructive pulmonary disease, and elective total hip and total knee arthroplasty. Risk managers, along with administrators, medical leadership, patient safety officers, and other key staff, should evaluate the organization's readmission rates and determine the best way to reduce preventable readmissions. Efforts may include measures to ensure high-quality, evidence-based care throughout the patient's stay; comprehensive discharge planning and teaching; and effective coordination and communication with other healthcare providers. Incorporating findings from studies such as the ones described above into quality improvement initiatives can help to identify problems and possible interventions.