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READMISSIONS: 7-day and 30-day rates for U.S., 2014

In 2014, the U.S. 7-day readmission rate was 5 percent and the 30-day rate was 14 percent, according to this new report released by the U.S. Agency for Healthcare Research and Quality (AHRQ).  The data are derived from the Healthcare Cost and Utilization Project (HCUP) and are based on all-payer data – not limited to Medicare data.

This Statistical Brief provides data on the most frequent causes of readmission at both of those points in time.  The most frequent causes are similar at 7 days and at 30 days.  Here is the list for 7-day readmissions, in rank order:

  1. Schizophrenia and other psychotic disorders (9 percent)
  2. Alcohol-related disorders (7.5 percent)
  3. Congestive heart failure, nonhypertensive (7.4 percent)
  4. Heart valve disorders (7.3 percent)
  5. Hypertension with complications, secondary hypertension (7.2 percent)

Here is the list for 30-day readmissions, in rank order:

  1. Congestive heart failure (23.2 percent)
  2.  Schizophrenia and other psychotic disorders (22.9 percent)
  3. Respiratory failure; insufficiency; arrest, adult (21.6 percent)
  4. Alcohol-related disorders (21.5 percent)
  5. Deficiency and other anemia (21.2 percent)

This report also provides a breakout of the most common causes of readmission by payer type (Medicare, Medicaid, private insurance and uninsured).

Note: These readmission rate percents represent readmissions per 100 index inpatient stays.

Source: Fingar, K.R., Barrett, M.L., and Jiang, H.J. (2017, October). A comparison of all-cause 7-day and 30-day readmissions, 2014. Statistical Brief, 230.  Click here for free full text: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

ORTHOPEDICS: 30-day readmission rates for total hip and total knee replacement

The readmission rate for total hip replacement and total knee replacement procedures performed recently on patients in California, Florida and Massachusetts was studied.  Here are the findings for the percent of these patients readmitted within 30 days:

  • 4.29 percent (California during the period 2009 to 2011)
  • 4.7 percent (Florida during the period 2009 to 2013)
  • 3.92 percent (Massachusetts during the period 2009 to 2012)

The authors analyzed the role of infection in these 30-day readmissions, finding that in about one-third of the total hip and total knee arthroplasty patients, infection was listed as the primary or secondary reason for readmission.

Source: A retrospective study. Medicine, 96(38). Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617700/pdf/medi-96-e7961.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: How to reduce bounce back from SNFs

After an inpatient stay in the hospital, some patients are discharged to skilled nursing facilities (SNFs) for continued recuperation and therapy.  This article summarizes the findings of a literature search of studies on how to avoid bounce back – readmission of these patients from the SNF to the hospital within 30 days.  Learnings about barriers and strategies from the 10 studies are compared in this article.

Source: Mileski, M., and others. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222. Click here for free full text: https://www.dovepress.com/getfile.php?fileID=34598.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Top 10 most frequent DRGs for 30-day hospital readmissions, U.S. 2013

These are data collected by the federal government – the Agency for Healthcare Research and Quality – as part of the Healthcare Cost and Utilization Project (HCUP) Nationside Readmissions Database, 2013.  This is a free database – our tax dollars spent for interesting national data.

Top 10 DRGs by NUMBER of 30-Day Readmissions
[Note: The DRG official names are longer – explicitly including or excluding complications and comorbidities, for example.  I’ve shortened the names below.  Please see the source for the full condition names.

  • 184,730  DRG 885: Psychoses
  • 113,376  DRG 871: Septicemia
  •   96,130  DRG 392: Esophagitis
  •   79,908  DRG 292: Heart failure (with complications or comorbidities)
  •   69,847  DRG 291: Heart failure (with major complications or comorbidities)
  •   62,852  DRG 847: Chemotherapy without acute leukemia as secondary diagnosis
  •   54,304  DRG 812: Red blood cell disorders
  •   53,224  DRG 683: Renal failure
  •   51,039  DRG 194: Simple pneumonia & pleurisy
  •   50,719  DRG 190: Chronic obstructive pulmonary disease

Top 10 DRGs by PERCENT of Cases That Are 30-Day Readmissions

  • 86 percent  DRG 780: False labor
  • 72 percent  DRG 839: One of the chemotherapy DRGs
  • 70 percent  DRG 847: Another of the chemo DRGs
  • 67 percent  DRG 838: Another of the chemo DRGs
  • 67 percent  DRG 846: Another of the chemo DRGs
  • 67 percent DRG  848: Another of the chemo DRGs
  • 51 percent  DRG 778: Threatened abortion
  • 49 percent  DRG 834: One of the acute leukemia DRGs
  • 46 percent  DRG 835: Another of the acute leukemia DRGs
  • 36 percent  DRG 840: Lymphoma and non-acute leukemia

Source: U.S. Agency for Healthcare Quality and Research. All patient readmissions within 30 days: National statistics, 2013.  Click here: http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=4955DDB08ECF260B&Form=SelDXPR&JS=Y&Action=%3E%3ENext%3E%3E&_DXPR=PreRunDRG   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

30-DAY READMISSIONS: 6.1 percent after surgery in this large-scale study of six procedures

The 30-day readmission rate following 6 surgical procedures was studied based on data from 346 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.  The data were for the calendar year 2012 and included nearly half a million patients.  The investigators looked at both the all-cause and the unplanned readmission rate.  Here are a few interesting data points:

30-DAY READMISSION RATE

  • 6.1 percent (overall for the 6 procedures studied), all-cause
  • 5.7 percent (overall for the 6 procedures studied), unplanned
  • 4.5 percent (total hip or knee), all-cause
  • 4.3 percent (total hip or knee), unplanned

The other procedures studied were: bariatric, colectomy or proctectomy, ventral hernia repair, hysterectomy, and lower extremity vascular bypass.

Source: Merkow, R.P., Ju, M.H., and others. (2015, Feb. 3). Underlying reasons associated with hospital readmission following surgery in the United States. JAMA, 313(5), 438-495. Click here for the publisher’s website: http://jama.jamanetwork.com/article.aspx?articleid=2107788   Posted by AHA Resource Center (312) 422-2003, rc@aha.org