Hospital readmission depends on where you live, study finds

How likely you are to be readmitted to the hospital after discharge depends mostly on where you live, not how well doctors prepare you for going home. That's the conclusion of a study out this week in the New England Journal of Medicine.

Researchers from Harvard and elsewhere looked at more than 450,000 hospital admissions and readmissions in 2008 for Medicare patients with congestive heart failure or pneumonia. When they analyzed by region, they found large variations in the rate of readmission, from a low of 11 percent to a high of 32 percent for heart failure, and 8 percent to 27 percent for pneumonia.

The primary predictor of whether they would be readmitted, the researchers found, was the overall rate of utilization of hospitals in the region. In places where lots of people go to the hospital, lots end up being readmitted, too. Further, the number of cardiologists in a given region also increased the chance that patients discharged after hospitalization for heart failure would be readmitted.

That finding, the researchers said, suggests that the key to lowering readmission rates is not just improving patient communication or discharge planning, but changing a community's medical culture, a more complex task. For example, new reimbursement methods that discourage medical overuse, and encourage good patient outcomes, might cut back on unnecessary hospitalizations, and rehospitalizations. The new health reform law encourages the development of such programs.

Our updated hospital Ratings found that heart attack, heart failure, and pneumonia patients at the average U.S. hospital had a 20 percent chance of being readmitted within 30 days of their initial discharge. And 70 percent of hospitals received our lowest or second lowest Rating for hospital readmissions.

For details, see our updated hospital Ratings, which includes information not only on readmissions but also on infection rates and patient satisfaction. And read our story on the six steps you can take to make the discharge process smoother.

Source:
The Relationship between Hospital Admission Rates and Rehospitalizations [NEJM]

—Kevin McCarthy