Key result
Lowest-volume hospitals linked to ~1.2% lower 30-day readmission rates vs highest-volume centers.
Why the study?
The association of hospital volume, a marker of quality of care, with hospital readmission rates was unclear.
Does higher hospital volume reduce 30-day standardized readmission rates in Medicare patients?
Population
6,916,644 adult discharges from 4,651 US acute care hospitals excluding psychiatric or medical cancer treatment
Comparison
Lowest hospital volume quintile vs highest hospital volume quintile
Design
Retrospective cross-sectional study
Follow-up
30 day
Authors
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Low-volume hospitals had fewer readmissions than high-volume ones; challenges volume-outcome consensus and leaves open whether readmissions measure distinct quality domains.
Cross-Sectional (n=6,916,644)
Yes
Does higher hospital volume reduce 30-day standardized readmission rates in Medicare patients?
Mean Difference: 1.2 (95% CI 0.9–1.5)
Absolute Event Rate: 14.7% vs 15.9%
p-value: p=<0.001
Contrary to the typical association of higher hospital volume with better outcomes, lower hospital volume is associated with lower 30-day standardized readmission rates, suggesting readmissions reflect different aspects of care quality than mortality.
Horwitz et al. (2015) conducted a cross-sectional in Hospital readmission (n=6,916,644). Lowest hospital volume quintile vs. Highest hospital volume quintile was evaluated on 30-day standardized readmission rate (MD 1.2, 95% CI 0.9 to 1.5, p=<0.001). Hospitals in the lowest volume quintile had a significantly lower mean 30-day standardized readmission rate (14.7%) compared to those in the highest volume quintile (15.9%, P<0.001).
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