Per the results of a nationwide cohort study published in Annals of Internal Medicine, early hospital readmissions were more likely to be preventable compared with late readmissions. Additionally, early readmissions were more amenable to hospital-based interventions, whereas late readmissions were more amenable to ambulatory and home-based interventions.
The prospective cohort study captured readmission data for 822 adults across 10 participating academic medical centers in the United States. For each readmission, a site-specific physician adjudicator assessed preventability and additional clinical characteristics. Readmissions within 7 days of discharge were compared with readmissions between 8 and 30 days of discharge, described as “early” and “late” readmissions, respectively.
Of the 822 eligible patients, 301 (36.6%) were readmitted 0 to 7 days after discharge and 521 (63.4%) were readmitted 8 to 30 days after discharge. Per adjudicator assessments, 36.2% of early readmissions were preventable vs 23.0% of late readmissions, for a median risk difference of 13.0 percentage points across participating sites. In adjusted analyses, early readmissions were significantly more likely to be preventable (odds ratio, 2.0; 95% CI, 1.5-2.8).
Hospitals were identified as the ideal location for intervention for 47.2% of early readmissions compared with 25.5% of late readmissions. Outpatient clinics (15.2% vs 6.6%) and home (19.4% vs 14.0%) were cited as the most successful sites of intervention for late readmissions vs early readmissions.
Problems with physician decision making regarding diagnosis and management were identified as factors more frequently contributing to early vs late readmissions, while monitoring and managing postdischarge symptoms and end-of-life planning were identified as factors more frequently contributing to late vs early readmissions.
The researchers noted that expanding the study to include community hospitals would increase data generalizability. These findings may be helpful for clinicians and hospital personnel in amending clinical practices to lessen the rate of preventable readmissions.
Graham KL, Auerbach AD, Schnipper JL, et al. Preventability of early versus late hospital readmissions in a national cohort of general medicine patients. Ann Intern Med. 2018;168(11):766-774.