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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

 

200 Hospital Benchmarks

Becker’s Hospital Review has updated and expanded its earlier 40 Hospital Benchmarks article to provide 200 national benchmarks for hospitals related to quality processes and outcomes, the patient experience, and financial and operational performance. Among the new indicators added are census disparity index benchmarks used for decision making on patient load measurement, budgeting, and projection of staffing needs. Also added are admissions, discharges, and transfers index benchmarks indicating the proportion of a hospital unit’s patient population turnover during the day, evening and night shifts, impacting patient flow. The benchmarks have been compiled from both government and commercial sources.

Source: Gamble M. 200 hospital benchmarks. Becker’s Hospital Review, Sept. 27, 2011.  http://www.beckershospitalreview.com/hospital-management-administration/200-hospital-benchmarks.html

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Postacute care facilities can help cut readmission rate

SunBridge Healthcare, a postacute care multi-facility provider, is partnering with hospitals to reduce the 30-day hospital readmission rate.  The company’s goal is to cut the readmission rate to under 10 percent.  Among the strategies are to look for services that could be added to the nursing facilities (such as total parenteral nutrition), to establish protocols to care for patients with diagnoses that are frequently readmitted (such as congestive heart failure), and to hire more RNs.  SunBridge is also trying to increase awareness among local physicians of the capabilities of their nursing facilities.

Source: Maddy, C.  Halting hospitalizations.  Provider;37(7):35-37, July 2011.  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

The impact of nurse staffing on readmissions

To what extent does nurse staffing during hospitalization affect postdischarge outcomes? A recent article in Health Services Research explores three dimensions of this question:

  • the direct relationship between nursing unit staffing structure and hospital readmissions and emergency department visits within 30 days of discharge;
  • the indirect relationship due to quality of discharge teaching and patient readiness for discharge;
  • the economic relationship of investment in additional nurse staffing to cost savings in reduced postdischarge utilization.

Source: Weiss, M. E., Yakusheva, O. and Bobay, K. L. Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Services Research. Apr. 21, 2011. [Epub ahead of print] http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01267.x/abstract

Best practices to reduce readmissions for heart patients

Memorial Hermann Memorial City Medical Center (Houston, TX, 427 beds) ranks among the best hospitals in the country for low readmission rates for patients with acute myocardial infarction.  This case study examines changes made in the hospital’s heart and vascular institute that resulted in substantial performance improvement.  Of key importance were changes that resulted in a decrease in door-to-balloon time down to an average of 65 minutes.  Tips on how to achieve this are included in this white paper.

Source: Memorial Hermann Memorial City Medical Center: excellence in heart attack care reduces readmissions.  Case Study: High Performing Health Care Organization [The Commonwealth Fund], Feb. 2011.  http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Feb/1470_Lashbrook_Memorial_Hermann_readmission_case_study_web_version.pdf

Toolkit boosts best practice discharge process

Project BOOST, created in 2008 by the Society of Hospital Medicine with support from the John A. Hartford Foundation, provides an approach to improving the hospital discharge process with the goal of decreasing readmission rates among elderly patients.  Initial data from a handful of hospitals that have pioneered use of Project BOOST show a 21 percent reduction in their 30-day readmission rate for all causes.  More data, based on the first year experience of hospitals that have implemented Project BOOST are expected within the next few months.  The Project BOOST website includes a best practices section with an extensive literature review.

Sources: Society of Hospital Medicine.  Project BOOST: Improving the Care of Patients as They Transition from Hospital to Home, [2011?].  http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/PDFs/Project_BOOST_Fact_SheetFinal.pdf ; and, the Boosting Care Transitions website.

Preventing readmissions through effective discharge processes

Improving the hospital discharge process can have a significant impact on hospital readmissions. According to a study by the Agency for Healthcare Research and Quality (AHRQ), patients who understand their instructions for after-hospital care, such as how to take medications and when to make follow-up appointments, are 30 percent less likely to visit the emergency department or be readmitted to the hospital. AHRQ provides information and tools that are designed to help clinicians implement more effective discharge processes, including:

  • Project RED (Re-engineered Discharge)–an approach that prepares patients for discharge from the moment they arrive in the hospital
  • Project BOOST–a “discharge bundle” consisting of medication reconciliation forms, a checklist for patient-centered hospital discharge education, and a checklist for post-discharge continuity checks

For more information on these tools, as well as tips for consumers , see http://www.ahrq.gov/qual/impptdis.htm.

Source: Improving the Hospital Discharge Process. Rockville, MD: Agency for Healthcare Research and Quality, Feb. 2011.