It's a complex, system-wide problem, expert says
TUESDAY, Jan. 22, 2013 (HealthDay News) -- As many as one in five people who have been hospitalized may end up back in the hospital -- either in the emergency room or readmitted as an inpatient, according to two large new studies of millions of U.S. patients.
The first study found that about 20 percent of people discharged from the hospital ended up needing acute care within the next 30 days. The second study looked at readmission rates for specific conditions -- heart failure, heart attack and pneumonia -- and found readmission rates between 18 percent and 25 percent within a month.
"We know that readmissions have been a problem for some time, yet we don't seem to be able to crack this nut and figure out a way to reduce readmissions," said Dr. Anne-Marie Audet, vice president of health system quality and efficiency for the Commonwealth Fund in New York City.
"Readmission rates are a measure that shows that the system for care is not integrated well enough. It's not necessarily an indicator that the hospital is poor quality or the primary-care physician is poor quality -- it's the whole system," Audet said. "The only way we can achieve better health, better health outcomes and better cost is to bring everyone together. But it's quite a complex issue."
Audet co-wrote an editorial that accompanied the two new studies, which were published in the Jan. 23 issue of the Journal of the American Medical Association.
The first study is an example of how complex an issue readmission rates can be. Although anyone readmitted for inpatient care is considered a readmission, if someone seeks care in the emergency room after being discharged from the hospital and is then released from the ER, they are generally not counted as a readmission. Clearly these people are an indication of a problem in the transition of care from the hospital to a primary-care doctor, Audet said.
To get a better idea of how often people recently discharged from the hospital sought acute care, researchers reviewed data on more than 4 million adult hospitalizations in three large, geographically diverse areas in California, Florida and Nebraska. The average age of the hospitalized patient was 53.
Following discharge from the hospital, about 18 percent of those released ended up needing some type of acute care during the next 30 days. Of those people, 40 percent went to the emergency department. For every 1,000 discharges, 97.5 people went to the ER and were treated and released, while roughly 147 per 1,000 were readmitted to the hospital within 30 days.
"We see so many people in the emergency department that have just been in the hospital, and many patients come back for a prescription refill or for reassurance. There's a gap in care that brought them back to the emergency department," said study leader Dr. Anita Vashi, an ER physician and distinguished scholar at the Yale University School of Medicine in New Haven, Conn.
The second study reviewed more than 3 million hospital discharges in Medicare patients and found that nearly 25 percent of those hospitalized for heart failure were readmitted within 30 days of discharge. Of those who were hospitalized for heart attack, almost 20 percent were readmitted to the hospital within that time frame. Of those hospitalized for pneumonia, more than 18 percent had to be readmitted.
Most of the readmissions occurred within the first 15 days after discharge, according to the study. Most of the patients were readmitted for a different condition than the one for which they were initially hospitalized.
"We are just now recognizing that upon leaving the hospital, patients may have entered a transient period of generalized risk," senior study author Dr. Harlan Krumholz, a distinguished professor of medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, said in a Yale news release. "Patients need to know that they are at risk for rehospitalization from a wide variety of medical conditions."
Vashi said it's important for patients to know they might be more vulnerable in the period after they have been discharged from the hospital.
If you have been in the hospital, she said, make sure you understand your discharge instructions, such as what medicines you should take and when, and what is normal as incision sites heal. She said to try to address all of your concerns before you leave the hospital, but to find out whom you should call if you have any concerns after you're home.
Learn what you need to know when you leave the hospital from the U.S. Agency for Healthcare Research and Quality (http://www.ahrq.gov/qual/goinghomeguide.htm#guide ).
SOURCES: Anita Vashi, M.D., M.P.H., emergency room physician, Robert Wood Johnson Clinical Scholar, VA Scholar, Yale University School of Medicine, New Haven, Conn.; Anne-Marie Audet, M.D., M.Sc., vice president, health system quality and efficiency, Commonwealth Fund, New York City; Jan. 22, 2013, news release, Yale University School of Medicine; Jan. 23, 2013, Journal of the American Medical Association