Late Hospital Readmissions Linked To Chronic Health and Social Problems

MedicalResearch.com Interview with:
Kelly L. Graham, MD, MPH

Instructor in Medicine
Harvard Medical School Division of General Medicine and Primary Care
Beth Israel Deaconess Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Graham: 30-day readmissions have become a standard quality metric used to represent inpatient quality of care and unnecessary healthcare utilization.  Effective 10/1/2009, hospitals with excess 30-day readmissions have been faced with financial penalties.  Experts have questioned the validity of this metric, and have raised concerns about the potential unintended consequence of creating health disparities, as critical access hospitals caring for the most socioeconomically burdened patients have faced the highest penalties. We were interested to see if factors associated with readmissions in the early part of the 30 day window (0-7 days post-discharge) differed from those associated with the later window (8-30 days post-discharge), ultimately attempting to better understand the “pathophysiology” of a readmission.

Our findings suggest that early readmissions are associated with many factors, including those related to the index admission (acute illness burden and suboptimal discharge timing), and factors that are not related to the index hospitalization, such as chronic illness burden and social determinants of health.  In contrast, late readmissions were only associated with chronic illness burden and social determinants of health.

Medical Research: What should clinicians and patients take away from your report?

Dr. Graham: This study is the first to our knowledge to study how readmissions differ within the 30 days following discharge, and provides some insights about how potential interventions may differ for preventing early vs. late readmissions.  It suggests that hospitals should continue to provide the highest quality of care for the acute presenting illness, but that the primary care community around the hospital is also vital in optimizing access for care of ambulatory sensitive chronic conditions and mobilizing social supports in the community to prevent readmissions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Graham: This is hopefully the first of many studies in this domain.  We are in the process of looking closer at the question of preventability directly, using chart review and a validated algorithm, and repeating our analysis using data from more hospitals, with the goal of improving the generalizability of our findings.

Citation:

Graham KL, Wilker EH, Howell MD, Davis RB, Marcantonio ER. Differences Between Early and Late Readmissions Among Patients: A Cohort Study. Ann Intern Med. 2015;162:741-749. doi:10.7326/M14-2159

Kelly L. Graham, MD, MPH, Instructor in Medicine, Harvard Medical School Division of General Medicine and Primary Care, & Beth Israel Deaconess Medical Center (2015). Late Hospital Readmissions Linked To Chronic Health and Social Problems