Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients

Abstract

Background: Many experts believe that hospitals with more frequent readmissions provide lower-quality care, but little is known about how the preventability of readmissions might change over the postdischarge time frame.

Objective: To determine whether readmissions within 7 days of discharge differ from those between 8 and 30 days after discharge with respect to preventability.

Design: Prospective cohort study.

Setting: 10 academic medical centers in the United States.

Patients: 822 adults readmitted to a general medicine service.

Measurements: For each readmission, 2 site-specific physician adjudicators used a structured survey instrument to determine whether it was preventable and measured other characteristics.

Results: Overall, 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference, 13.0 percentage points [interquartile range, 5.5 to 26.4 percentage points]). Hospitals were identified as better locations for preventing early readmissions (47.2% vs. 25.5%; median risk difference, 22.8 percentage points [interquartile range, 17.9 to 31.8 percentage points]), whereas outpatient clinics (15.2% vs. 6.6%; median risk difference, 10.0 percentage points [interquartile range, 4.6 to 12.2 percentage points]) and home (19.4% vs. 14.0%; median risk difference, 5.6 percentage points [interquartile range, -6.1 to 17.1 percentage points]) were better for preventing late readmissions.

Limitation: Physician adjudicators were not blinded to readmission timing, community hospitals were not included in the study, and readmissions to nonstudy hospitals were not included in the results.

Conclusion: Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.

Primary funding source: Association of American Medical Colleges.

Figure 1:

Proportion of early and late readmissions that were preventable at each of the ten hospital sites.

Figure 2:

Pooled, adjusted proportion of readmissions ascertained as preventable using a standard algorithm and physician adjudication at all ten hospital sites. The bottom and top edges of the boxes represent the pooled 25^th and 75^th percentiles, the center horizontal line is drawn at the 50^th percentile (median), and the vertical lines represent the most extreme observations.