A meta-analysis of hospital 30-day avoidable readmission rates

被引:137
作者
van Walraven, Carl [1 ,2 ,3 ]
Jennings, Alison [1 ]
Forster, Alan J. [1 ,2 ,3 ]
机构
[1] Ottawa Hosp, Clin Epidemiol Program, Res Inst, Ottawa, ON K1Y 4E9, Canada
[2] Univ Ottawa, Fac Med, Ottawa, ON, Canada
[3] Inst Clin Evaluat Sci, Ottawa, ON, Canada
关键词
avoidable; meta-analysis; preventable; rates; readmission; re-hospitalization; QUALITY-OF-CARE; INDICATOR; PATIENT;
D O I
10.1111/j.1365-2753.2011.01773.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Rationale and objectives Urgent readmission to hospital is commonly used to measure hospital quality of care. Hospitals that measure the proportion of urgent readmissions judged avoidable need to know previously published rates for comparison. In this study, we generated a literature-based estimate for the proportion of 30-day urgent readmissions deemed avoidable for hospitals to use to gauge their performance in avoidable readmissions. Methods We searched the Medline and Embase databases to identify published studies that reported the proportion of 30-day urgent readmissions deemed avoidable. We then modelled the overall proportion of 30-day urgent readmissions deemed avoidable. Results We included 16 studies that used a wide variety of patients and a diverse range of methods to classify readmissions as avoidable. Studies reported a broad range for the proportion of urgent 30-day readmissions deemed avoidable. Overall, 848 of 3669 readmissions (23.1%, 95% confidence interval, 21.724.5) of 30-day urgent readmissions were classified as avoidable. This proportion varied significantly based on hospital teaching status and number of reviewers for each case [teaching hospitals: with one reviewer, 9.3% (4.219.3); with >1 reviewer, 21.6% (13.233.3); non-teaching hospital: with one reviewer, 32.2% (11.463.9); with >1 reviewer, 39.9% (37.642.2)]. Significant heterogeneity remained between studies even after clustering studies by these covariates. Conclusions Less than one in four readmissions were deemed avoidable. Health system planners need to use caution in interpreting all cause readmission statistics as they are only partially influenced by quality of care.
引用
收藏
页码:1211 / 1218
页数:8
相关论文
共 28 条
[1]  
[Anonymous], The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta- Analysis
[2]  
[Anonymous], 2010, PHYSIOTHERAPISTS CAN
[3]  
[Anonymous], J CLIN EXCELLENCE
[4]   A conceptual framework for the study of early readmission as an indicator of quality of care [J].
Ashton, CM ;
Wray, NP .
SOCIAL SCIENCE & MEDICINE, 1996, 43 (11) :1533-1541
[5]   Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems [J].
Balla, Uri ;
Malnick, Stephen ;
Schatmer, Ami .
MEDICINE, 2008, 87 (05) :294-300
[6]   Hospital readmissions as a measure of quality of health care -: Advantages and limitations [J].
Benbassat, J ;
Taragin, M .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (08) :1074-1081
[7]  
Centers for Medicare & Medicaid Services, 2010, HOSP COMP
[8]   ARE READMISSIONS AVOIDABLE [J].
CLARKE, A .
BRITISH MEDICAL JOURNAL, 1990, 301 (6761) :1136-1138
[9]   28-day emergency surgical re-admission rates as a clinical indicator of performance [J].
Courtney, EDJ ;
Ankrett, S ;
McCollum, PT .
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, 2003, 85 (02) :75-78
[10]  
Fleiss JL., 2003, STAT METHODS RATES P, V3rd, P17