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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

HIP FRACTURES: Patient characteristics, outcomes, surgical volume: Data from Kaiser Permanente registry

What are the outcomes for patients who have had surgery after breaking a hip?  This is a study of the Kaiser Permanente Hip Fracture Registry – looking at over 12,000 patients in California in 2009 through 2011.  The registry data includes 33 medical centers and 474 surgeons.  Here is a look at this data-rich article:

Characteristics of Patients with Broken Hips

  • Two-thirds are female
  • Two-thirds are 75 years or older
  • Over half have 3 or more other medical problems (comorbidities)
  • Two-thirds have hypertension

Patient Outcomes

  • 4-day length of stay (median)
  • 6.2 percent death within 30 days
  • 12.3 percent death within 90 days
  • 12.2 percent readmission within 30 days
  • 22.1 percent readmission within 90 days
  • 11.4 percent contracted pneumonia
  •   1.1 percent surgical site infection

Surgeon Characteristics

  • 12.1 percent low volume (less than 10 procedures / year)
  • 68.4 percent medium volume (10 to 29 procedures / year)
  • 19.5 percent high volume (30+ procedures / year)

Hospital Characteristics

  •   1.7 percent low volume (less than 60 procedures / year)
  • 35.3 percent medium volume (60 to 129 procedures / year)
  • 63.0 percent high volume (130+ procedures / year)

Source: Inacio, M.C.S., and others. (2015, Sum.). A community-based hip fracture registry: Population, methods, and outcomes. The Permanente Journal, 19(3), 29-36.  Click here for free full text: http://www.thepermanentejournal.org/files/Summer2015/Registry.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Benchmarks: Trends in 30-day readmission rate for US, states, counties, hospitals (Medicare data)

MEDICARE 30-DAY READMISSION RATES: U.S. national average
Year All Medical All Surgical CHF AMI Pneumonia
2004 15.9% 12.7% 20.9% 19.4% 15.1%
2008 16.2% 12.7% 21.4% 18.7% 15.3%
2009 16.1% 12.7% 21.2% 18.5% 15.3%
2010 15.9% 12.4% 21.1% 18.1% 15.3%
2011 15.9% 12.3% 21.1% 17.8% 15.3%
2012 15.5% 12.0% 20.5% 16.8% 14.9%

Notes:

  • CHF: Congestive heart failure
  • AMI: Acute myocardial infarction
  • The data are from a FREE interactive website that can be adjusted to provide data for other geographies – state, county, hospital referral regions – or for individual hospitals.
  • I generated these data on 12/29/15 using the interactive website; and double-checked them by re-generating them.
  • 2012 is the most current year for which data are available as of this writing (12/29/15)

Source: The Dartmouth atlas of health care. (2015). Lebanon, N.H.: The Dartmouth Institute for Health Policy and Clinical Practice. Retrieved from http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=30  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

All cause 30-day readmissions: US national statistics, 2011

The HCUPnet data site is a lot of fun to explore.  I’d like to highlight national readmission data from HCUPnet in this blog post, but there is a tremendous amount of other fascinating data as well.

Here’s your quiz question for today:  what do you think the top condition is as far as resulting in the highest PERCENT of patients being readmitted within 30 days.  I predict that you’ll say, “Well, of course!” when I tell you.

  • FALSE LABOR!  Yes, not surprisingly, well over three-quarters of patients admitted with DRG 780 (false labor) show up again at a hospital within 30 days.  In fact, it surprises me that the percentage is not higher than that.

These are national figures derived from the U.S. Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project.  The most current dataset available at this time is for 2011.

Let’s look at some often-requested conditions:

  • Heart attack (DRGs 280, 281, 282) — there are three different codes that pertain to people who are hospitalized with heart attack and survive, depending on whether they have other medical conditions complicating their recovery.  The 30-day readmission rate ranges from 14 to 26 percent depending on which of these three different DRG codes we are looking at.
  • Pneumonia (DRGs 193, 194, 195) — like for heart attack, patients admitted for simple pneumonia & pleurisy might be coded in either of 3 different DRGs,  The 30-day readmission rate for these three DRGs ranges from about 9 percent to 21 percent, depending on which of the three DRGs we are looking at.

As a bonus, this data source also provides the MEAN COST PER READMISSION by DRG, nationally.

Source: Agency for Healthcare Research and Quality. (2014). Hospital Readmissions.  Click here to access this free website: http://hcupnet.ahrq.gov/ .  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Readmission rate: No relationship with length of stay

In a study of over 4100 adult patients who received care 2004 to 2006 at one academic medical center, researchers found that there was no statistically significant relationship between a longer or shorter length of stay in the hospital and the likelihood that the patient would be readmitted either at 30 days or at 120 days. 

  • The interesting conclusion: “In summary, hospital care, as measured by the incremental probability of readmission for every incremental day in LOS [length of stay], has no association with readmission.  If our findings are confirmed at other hospitals, then more hospital care may not be the mechanism for reducing readmission rates.  If that is the case, then denying payment for readmission may be likely unwarranted.” (p. 73)

Source: Johnson, T., and others.  [Rush University].  Hospital care may not affect the risk of readmission.  Quality Management in Health Care;21(2):68-73, Apr./June 2012.  Click here to access article on publisher’s website: http://journals.lww.com/qmhcjournal/Fulltext/2012/04000/Hospital_Care_May_Not_Affect_the_Risk_of.2.aspx  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org