Preventability of early vs. late readmissions in an academic medical center

PLoS One. 2017 Jun 16;12(6):e0178718. doi: 10.1371/journal.pone.0178718. eCollection 2017.

Abstract

Background: It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.

Objective: Compare preventability of hospital readmissions, between an early period [0-7 days post-discharge] and a late period [8-30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.

Design, setting, patients: 120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010.

Measures: Sum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.

Results: Readmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1-6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].

Conclusions: Readmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission*
  • Retrospective Studies
  • Time Factors

Grants and funding

EM is supported by a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging (K24 AG035075 and R01 AG030618). This work was also conducted with support from Harvard Catalyst (NIH Award #1UL1 TR001102-01) and financial contributions from Harvard University and its affiliated academic health care centers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.