Efforts to Reduce Hospital Admission Rates Also Reduce Readmissions

Recent research in Health Affairs found that programs and initiatives designed to lower hospital admission rates may also reduce 30-day readmission rates, despite previous findings that patients affected by these programs tend to be sicker.

Lead researcher Dr Kumar Dharmarajan, MD, assistant professor of cardiology at the Yale University School of Medicine, also said federal programs that incentivize reductions in both hospital admission rates and readmission rates are not in conflict with each other.

 “We're showing that communities can do a good job of improving both population health and outcomes after hospitalization,” he said in a press release. “These goals are not in conflict. Doing the right thing for the patient in one setting seems to help in other settings as well.”

Dr Dharmarajan and colleagues studied data for elderly patients for 2010 and 2013 from the Medicare Provider Analysis and Review (MedPAR) files. In order to characterize changes in rates from 306 hospital referral regions, they compared 8,732,001 hospital admissions and 1,478,309 readmissions for 2010 with 7,942,946 hospital admissions and 1,252,773 readmissions for 2013. The researchers also conducted an initial analysis to confirm the previously reported hypothesis that reductions in hospital admission rates resulted in sicker hospitalized patients. Mortality was also examined to account for patients ineligible for readmission due to death outside of the hospital.

Study results showed that hospital referral regions with the largest reductions in admissions also had the largest reductions in 30-day readmissions, despite confirming that patients in these regions were sicker. The researchers found that median admission rates across the US decreased from 30.8 per 100 person years in 2010, to 27.1 in 2013. Likewise, the median 30-day all cause readmission rate decreased from 17.2 to 16.1 per 100 person years. Statistical analysis revealed that 45% of hospital regions in the upper quartile for decreases in admissions were also in the upper quartile for decreases in readmissions, while 76% of regions were in the upper half. The reasons why declining trends in admission and readmission rates mirror one another are not currently known, according to the study.

The researchers also found that reductions in hospital admission rates were associated with sicker hospitalized patients. They noted that regions with lower admission rates tended to have increased 30-day hospital mortality rates per 100 admissions.

Dr Dharmarajan and colleagues concluded that investments in strategies to reduce admission rates could be successful without damaging readmission rates. Additionally, they stated that federal policies designed to incentivize reductions in both admissions and readmissions do not create conflicting incentive goals. –David Costill

Reference:

Dharmarajan K, Qin L, Lin Z, et al. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Aff. 2016;35(7):1294-1302.