Preventability of early vs. late readmissions in an academic medical center.
<h4>Background</h4>It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.<h4>Objective</h4>Compare preventability of hospital readmissions, between an early period [0-7 days post-discharge] and a late period [8-30 days post-disch...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178718&type=printable |
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| Summary: | <h4>Background</h4>It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.<h4>Objective</h4>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.<h4>Design, setting, patients</h4>120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010.<h4>Measures</h4>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.<h4>Results</h4>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].<h4>Conclusions</h4>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. |
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| ISSN: | 1932-6203 |