Hospital readmissions

One in five Medicare beneficiaries is readmitted to the hospital within 30 days of discharge.

Readmissions to the hospital are common, costly, and believed by many to be an indication of sub optimal health care.

More than 2000 US hospitals are penalized upward of $200 million for readmissions of Medicare patients within 30 days of discharge.

The Hospital Readmissions Reduction Program (HRRP) was established by the Centers for Medicare and Medicaid Services in 2010 with the goal of reducing preventable hospitalizations by imposing financial penalties on hospitals with higher than expected 30 day readmission rates.

Readmissions to the hospital within 30 days of discharge occurs in as many as 20% of patients.

Fall-related injuries are a leading cause of 30-day readmission in older individuals who have recently been hospitalized, according to results from a study of more than 8.3 million Medicare beneficiaries.

Readmissions account for an estimated 17% of hospital payments received from Medicare in the US.

Greater than expected hospital readmission rates can trigger financial penalties from Medicare.

Readmissions have financial repercussions and continue to marginalize the most vulnerable patients.

Skilled nursing facilities are the most common setting for postacute care in the US and readmission rates from such institutions are high.

One in four patients discharged to a SNF is readmitted within 30 days, and two-thirds of these readmissions may be preventable.

Among fee-for-service Medicare beneficiaries discharged to a SNF after acute-care hospitalization available performance measures were not consistently associated with differences in the adjusted risk of readmission or death (Neuman MD et al).

Given the increased numbers of elderly, frail patients it is not surprising that many patients are readmitted soon after hospital discharge.

One in 10 adult Medicaid patients is readmitted within 30 days of their index hospitalization.

Among Medicare beneficiaries the Hospital Readmissions Reductions Program was significantly associated with an increase in 30 day postdischarge morality after hospitalization for heart failure and pneumonia but not for AMI.

Older age, male gender, black race, or associate with higher readmission rates.

lower socioeconomic status is associated with higher hospitalization rates.

Readmissions following heart failure hospitalization are related to suboptimal transitional care in approximately 40% of cases.

Presently there is not a single intervention or a bundle of interventions that reliably reduce the risk of readmission that could be considered generalizable.

In a recent study death or readmission was reported in 26% of patients within 30 days of discharge and in 38% within 60 days of discharge for acute heart failure.

Reducing discontinuity between inpatient to outpatient setting is a key component to improving patient outcomes after a hospital discharge.

No single strategy has been universally effective at reducing hospital readmissions.

Most care coordination interventions rely on patient or family activation and engagement, such that socioeconomic status and level of social support influence effectiveness of interventions.

The highest readmission risks are associated in individuals who are least likely to accept or receive interventions to reduce readmission risk.