Cost-Effectiveness of QI Focused on Reducing Readmissions Uncertain

A recent study in JAMA Internal Medicine found that quality improvement interventions designed to prevent hospital readmissions were effective, but cost-savings varied significantly.

“Multifaceted quality improvement interventions can be effective, but neither the cost of implementation nor the potential savings associated with declines in hospitalization have been systematically evaluated,” Teryl K Nuckols, MD, MSHS, of the Cedars-Sinai Medical Center in Los Angeles, California, and colleagues wrote. “Furthermore, it remains unclear whether effective interventions tend to produce net savings or losses to the health system. Our objective was to systematically evaluate the clinical effectiveness and incremental net costs of QI interventions for the prevention of readmission to acute care hospitals, including within 30 days and over longer periods.”

In order to determine whether or not quality improvements design to reduce readmissions are cost effective, the researchers reviewed quality improvement literature and studies from PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat, from between 2004 and 2016. They compared risk difference in readmission rates against the net economic cost of quality improvements.

The researchers found that QI interventions reduced readmissions by 12.1% among heart failure patients and by 6.3% in the general population. The average savings per patient was $972 among heart failure patients and $169 among the general population. The researchers noted that variance in savings reflected statistically insignificant differences.

However, they did find that cost-savings were significant among general population quality improvement interventions that engaged patients and caregivers.

“Interventions that engage general populations of patients and their family members may be of higher value to the health system than other interventions because they are associated with similar effectiveness and substantially higher net savings,” they wrote.

“Interventions that are designed to reduce readmissions after hospital discharge are generally effective relative to the status quo, but net savings to health system perspective are uncertain owing to heterogeneity in results across studies,” Dr Nuckols and colleagues concluded.

—David Costill