Preventable Hospital Readmissions among Medicare Beneficiaries

Reducing preventable hospital readmissions is part of a federal strategy to create incentives to improve quality of care. In an effort to lower hospital readmission rates, the Centers for Medicare & Medicaid Services publicly reports readmission rates for heart failure (HF), acute myocardial infarction (MI), and pneumonia. These 3 conditions are responsible for nearly 15% of hospitalizations in older persons.

According to researchers, an understanding of the diagnoses and timing associated with events such as HF, MI, and pneumonia is critical to developing effective programs to reduce 30-day hospital readmissions. To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for HF, MI, or pneumonia, the researchers conduced an analysis of 2007-2009 Medicare fee-for-service (FFS) claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization. They reported results of their analysis in the Journal of the American Medical Association [2013;309(4):355-363].

The primary outcome measures of the analysis were: (1) percentage of 30-day readmissions occurring on each day (0-30) after discharge; (2) the most common readmission diagnoses occurring during cumulative periods (days 0-3, 0-7, 0-15, and 0-30) and consecutive periods (days 0-3, 4-7, 8-15, and 16-30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing.

The percentage of 30-day readmissions among patients hospitalized for HF was 24.8% (329,308 of 1,330,157 hospitalizations); for patients hospitalized for MI, the percentage was 19.9% (108,992 of 548,834 hospitalizations); and for patients hospitalized for pneumonia, the percentage was 18.3% (214,239 of 1,168,624 hospitalizations).

Among patients discharged following hospitalization for HF and acute MI, the most common reason for readmission after the index hospitalization was HF (35.2% and 19.3%, respectively). Among patients discharged following hospitalization for pneumonia, the most common reason for readmission was recurrent pneumonia (22.4%). Of all 30-day readmissions, the 5 most common readmission diagnoses comprised 55.9% of the HF readmission cohort, 44.3% of the acute MI readmission cohort, and 49.6% of the pneumonia readmission cohort.

Of all 30-day readmissions, 61.0% of the HF cohort, 67.6% of the acute MI cohort, and 62.6% of the pneumonia cohort occurred during days 0 through 15 after discharge. For all 3 cohorts, >30% of 30-day readmissions occurred during days 16 through 30.

For patients whose index hospitalization was for HF, median time to 30-day readmission was 12 days. For patients initially hospitalized for acute MI, median time to 30-day readmission was 10 days; for pneumonia patients, median time to 30-day readmission was 12 days. Median time for all 3 cohorts was comparable across common readmission diagnoses.

Finally, the analysis determined that readmission diagnoses and timing did not substantively vary by age, sex, or race.

In conclusion, the researchers commented, “Among Medicare FFS beneficiaries hospitalized for HT, acute MI, or pneumonia, 30-day readmissions were frequent throughout the month after hospitalization and resulted from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.”