Study Analyzes Hospital Stays, Not Illnesses to Reduce Readmissions
Observing the number of times a patient is admitted to the hospital and the lengths of those stays might provide better accuracy in preventing unnecessary readmissions, researchers found.
In a study published by JAMA Internal Medicine, researchers examined certain factors that could be tracked before a patient leaves the hospital, enabling clinicians to intervene and potentially prevent a return visit.
By creating a risk score that analyzes length of stay, number of stays, type of admission, as well as hemoglobin and sodium levels at discharge, researchers were able to reduce readmission rates by 8.5% from its cohort of 10,731 discharges.
“As expected and shown in prior studies of all-cause or unplanned readmissions, the number of prior hospitalizations and the length of stay of the index admission were important predictors of potentially avoidable readmission,” the study’s authors wrote.
The study used data for 9,200 patients who stayed at Brigham and Women’s Hospital for at least 24 hours between July 1, 2009 and June 30, 2010. Patients either did not return or were readmitted within 30 days to any of three Partners HealthCare hospital network, of which Brigham belongs.
Even though all planned readmissions for chemotherapy were excluded from the study’s outcome, being discharged from oncology service was still associated with a high risk of potentially avoidable readmission, researchers wrote.
Sodium and hemoglobin levels were found to be indicators of general prognosis, as they are in patients with heart failure, pulmonary embolism and pneumonia. These values, the study notes, are only available near the time of discharge and might limit the time available to effectively deploy an intensive discharge intervention.
While congestive heart failure has been commonly associated with a higher risk of 30-day readmissions, researchers found that this was not highly significant.
Rather, illness severity or clinical instability was found to be more attractive for researchers than the causes of hospital admissions or “comorbidities,” where a patient has two chronic illnesses.
Utilizing the HOSPITAL risk score model used in the study, researchers believe can provide a practical tool to assess 30-day potentially avoidable readmissions, as well as helping target transitional care for patients post-discharge.
Written by Jason Oliva