Key result
Observed-to-expected 30-day readmissions steadily declined across all risk strata despite rising baseline predicted risk.
Why the study?
It was unclear whether hospital readmission reduction efforts have changed the risk profile of hospitalized patients and whether reductions occurred similarly across low, medium, and high readmission risk groups.
Cohort (n=47,288,961)
Yes
Answers are grounded in this paper and cite their sources.
Hospitals have effectively reduced 30-day readmissions across all patient risk strata, while the predicted risk of readmission for hospitalized patients has increased in surgical and neurological cohorts but remained stable in medical and cardiovascular cohorts.
BACKGROUND: Hospitalization and readmission rates have decreased in recent years, with the possible consequence that hospitals are increasingly filled with high-risk patients. OBJECTIVE: We studied whether readmission reduction has affected the risk profile of hospitalized patients and whether readmission reduction was similarly realized among hospitalizations with low, medium, and high risk of readmissions. DESIGN: Retrospective study of hospitalizations between January 2009 and June 2015. PATIENTS: Hospitalized fee-for-service Medicare beneficiaries, categorized into 1 of 5 specialty cohorts used for the publicly reported hospital-wide readmission measure. MEASUREMENTS: Each hospitalization was assigned a predicted risk of 30-day, unplanned readmission using a risk-adjusted model similar to publicly reported measures. Trends in monthly mean predicted risk for each cohort and trends in monthly observed to expected readmission for hospitalizations in the lowest 20%, middle 60%, and highest 20% of risk of readmission were assessed using time series models. RESULTS: Of 47,288,961 hospitalizations, 16.2% (n = 7,642,161) were followed by an unplanned readmission within 30 days. We found that predicted risk of readmission increased by 0.24% (P = .03) and 0.13% (P = .004) per year for hospitalizations in the surgery/ gynecology and neurology cohorts, respectively. We found no significant increase in predicted risk for hospitalizations in the medicine (0.12%, P = .12), cardiovascular (0.32%, P = .07), or cardiorespiratory (0.03%, P = .55) cohorts. In each cohort, observed to expected readmission rates steadily declined, and at similar rates for patients at low, medium, and high risk of readmission. CONCLUSIONS: Hospitals have been effective at reducing readmissions across a range of patient risk strata and clinical conditions. The risk of readmission for hospitalized patients has increased for 2 of 5 clinical cohorts.
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Blecker et al. (2018) conducted a cohort in Hospitalized Medicare beneficiaries (n=47,288,961). Time (hospital readmission reduction efforts) was evaluated on Trends in monthly mean predicted risk of 30-day unplanned readmission and observed-to-expected readmission rates. Between 2009 and 2015, observed-to-expected 30-day readmission rates steadily declined across all patient risk strata, while the predicted risk of readmission increased slightly for surgery/gynecology and neurology patients.
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