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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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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| author | Kelly L Graham Ogechi Dike Lauren Doctoroff Marisa Jupiter Anita Vanka Roger B Davis Edward R Marcantonio |
| author_facet | Kelly L Graham Ogechi Dike Lauren Doctoroff Marisa Jupiter Anita Vanka Roger B Davis Edward R Marcantonio |
| author_sort | Kelly L Graham |
| collection | DOAJ |
| description | <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. |
| format | Article |
| id | doaj-art-170a0152df874df6b3d4d7a7aef5f825 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-170a0152df874df6b3d4d7a7aef5f8252025-08-20T02:46:00ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01126e017871810.1371/journal.pone.0178718Preventability of early vs. late readmissions in an academic medical center.Kelly L GrahamOgechi DikeLauren DoctoroffMarisa JupiterAnita VankaRoger B DavisEdward R Marcantonio<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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178718&type=printable |
| spellingShingle | Kelly L Graham Ogechi Dike Lauren Doctoroff Marisa Jupiter Anita Vanka Roger B Davis Edward R Marcantonio Preventability of early vs. late readmissions in an academic medical center. PLoS ONE |
| title | Preventability of early vs. late readmissions in an academic medical center. |
| title_full | Preventability of early vs. late readmissions in an academic medical center. |
| title_fullStr | Preventability of early vs. late readmissions in an academic medical center. |
| title_full_unstemmed | Preventability of early vs. late readmissions in an academic medical center. |
| title_short | Preventability of early vs. late readmissions in an academic medical center. |
| title_sort | preventability of early vs late readmissions in an academic medical center |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178718&type=printable |
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