Hospital Readmissions: Best US Hospitals Reduce Globally

Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical Interview with:
Kumar Dharmarajan MD MBA
Fellow in Cardiovascular Medicine
Columbia University Medical Center What were the main findings of the study

Dr. Dharmarajan: In the United States, 1 in 5 older patients is readmitted to the
hospital within 30 days of hospital discharge. However, there is great
variation in rates of 30-day readmission across hospitals, and we do
not know why some hospitals are able to achieve much lower readmission
rates than others.

We therefore wondered whether top performing hospitals with low 30-day
readmission rates are systematically better at preventing readmissions
from particular conditions or time periods after discharge. For
example, are hospitals with low 30-day readmission rates after
hospitalization for heart failure especially good at preventing
readmissions due to recurrent heart failure or possible complications
of treatment? Similarly, are top performing hospitals especially good
at preventing readmissions that occur very soon after discharge, which
may signify poor transitional care as the patient moves form the
hospital back home?

We found that hospitals with very different 30-day readmission rates
after hospitalization for heart failure, heart attacks, and pneumonia
had a similar spectrum of readmissions with regard to their diagnoses
and timing. In other words, high performing hospitals had a lower
absolute number of readmissions while maintaining a similar pattern of
readmission diagnoses and timing as lower performing institutions. Were any of the findings unexpected?

Dr. Dharmarajan: We actually hypothesized that top performing hospitals would show generalized excellence in reducing readmissions across all readmission
diagnoses and time periods after discharge, as previous studies have
linked high hospital performance with organizational and cultural
characteristics that would be expected to apply broadly to a range of
conditions and times after hospital discharge. What should clinicians and patients take away from your report?

Dr. Dharmarajan: Our study suggests that hospitals may best reduce readmissions with strategies that lower readmission risk globally rather than for specific diagnoses or time periods after admission.
The best performing hospitals in the United States have empirically reduced across the board. What recommendations do you have for future research as a result of this study?

Dr. Dharmarajan: We need to perform further studies of top performing hospitals to better understand the specific strategies they have used to reduce readmissions. This may call for predominantly qualitative methodologies, which are relatively infrequently used in health services research.



Dharmarajan K ,Hsieh AF ,Lin Z ,Bueno H ,Ross JS ,Horwitz LI ,et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ 2013;347:f6571