Potentially avoidable readmissions were relatively uncommon, comprising 16.0% of all urgent readmissions following hospital discharge, and hospital-specific readmission rates were not related to the proportion deemed avoidable.
Cohort (n=4,812)
Yes
Potentially avoidable urgent readmissions are relatively uncommon and do not correlate with overall hospital readmission rates, suggesting total readmission rates may be a poor proxy for quality of care.
BACKGROUND: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions. METHODS: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%. RESULTS: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval CI 12.5%-14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%-19.1%; 2.2% of those discharged, 95% CI 1.8%-2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%-22.5%; χ(2) = 92.9, p < 0.001); the proportion of readmissions deemed avoidable did not show significant variation by hospital (range 1.2%-3.7%; χ(2) = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41). INTERPRETATION: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission.
Walraven et al. (Mon,) conducted a cohort in Patients discharged to the community after elective or urgent hospital care (n=4,812). None (Observational) was evaluated on Potentially avoidable urgent readmission (probability >50% by latent class model) (95% CI 13.3%-19.1%). Potentially avoidable readmissions were relatively uncommon, comprising 16.0% of all urgent readmissions following hospital discharge, and hospital-specific readmission rates were not related to the proportion deemed avoidable.