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Literature Review: Readmissions and how geographical location of the hospitals affects the rate of readmissions. -Shubhshankar. What are Readmissions?. What are Readmissions?.
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Literature Review: Readmissions and how geographical location of the hospitals affects the rate of readmissions -Shubhshankar
What are Readmissions? • CMS defines readmission as an admission to a hospital 30 days within the previous discharge. Patient transferred to another hospital are not counted under readmission [1].
Reasons for Readmission:-Higher Propensity to get readmitted
Detailed review: Geographical location of hospitals[6]. • Boston :4.5 beds per thousand people. • New Haven : 2.9 beds per thousand.
Division into cohorts • Five cohorts:- myocardial infarction, stroke, gastrointestinal bleeding, curative surgery for lung, colon etc. • Rate of admission for these illness are similar as physicians agree on the need to hospitalize.
Results • Readmission rates in Boston were 1.64 times the readmission rates in New Haven.
Results • Higher readmission rates were not related to length of stay. • index admission :14.8 vs 13.5 days • readmission :11.3 vs 11.2 days The mortality rate was similar at both places
Explanations? • Severity of illness? • Nursing home care vs inpatient care?
Results • Association between availability of hospital beds and overall discharge rate. Possible explanation:-threshold of availability of beds plays a role in clinical decision making.
Solutions Identify population with high propensity to get readmitted • Weekly home visits or phone calls to monitor progress of the patient.
Solutions Follow up appointment with the patient’s physician. Complete discharge summaries within 24 hours
Questions? References :- • [1] Reducing hospital readmissions. By Jenny Minott • [2] Catlin, A. et al. “National Health Spending in 2006: A Year of Change for Prescription Drugs,” Health Affairs, January/February 2008, Vol. 27, No. 1, pp. 14-29. • [3] Medicare Payment Advisory Commission. 2007. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission, p. 103. • [4] Can readmission rates be used as an outcome indicator? Ruairidh Milne, Aileen Clarke • [5] Benbassat, J. and M. Taragin. “Hospital Readmissions as a Measure of Quality of Health Care,” Archives of Internal Medicine, Vol. 160, No. 8, 2000, pp. 1074-81. • [6] Hospital readmission rates for cohorts of medicare beneficiaries in Boston and New Haven by: E. S. Fisher, J. E. Wennberg, T. A. Stukel, S. M. Sharp