​Seven-day readmission rates may be a more accurate gauge of hospital quality than widely used 30-day readmission rates, according to a study published in the October 2016 issue of Health Affairs. The authors examined risk-standardized 90-day unplanned readmission risk data for Medicare patients 65 and older in Arizona, California, Florida, and New York with acute myocardial infarction, heart failure, or pneumonia. Although the study included a large and diverse population, the authors found very little variation between readmission rates across the board after the 30-day cutoff. They found that hospital quality and readmission rates had the strongest correlation after one day, an association that lessened rapidly until the seventh day, at which point correlation essentially vanished. Based on Centers for Medicare and Medicaid Services' (CMS) current risk standardization models, which adjust only for patient age, sex, and clinical characteristics, variation between hospitals then "rose slightly but steadily" from day 10 through day 90, which surprised the authors. However, the effect disappeared when the researchers adjusted for geographic and demographic determinants outside the hospital's control, such as state, rural, or urban location, and median household incomes, which CMS does not account for. The findings suggest that beyond the seventh day, readmissions were "explained by community- and household-level factors beyond the hospital's control," the authors said.

HRC Recommends: Patients recently discharged from the hospital may still be in a vulnerable state of health and are at risk of experiencing adverse events and preventable hospital readmissions if they do not receive adequate postdischarge care. Risk managers should work with nursing and medical staff and emergency department leaders to understand the characteristics of patients who may be most at risk for readmissions within their populations and take appropriate steps, including coordinating with colleagues in local postacute care organizations, to support patients after discharge and reduce readmission risks.