Hospitalists Assess the Causes of Early Hospital Readmissions

BACKGROUND: Hospital readmissions are receiving increasing attention as an indicator of health care quality and waste. Hospitalists provide a unique perspective on the underlying processes that result in acute care readmissions and the extent to which readmissions can be prevented. OBJECTIVE: The study assessed the views of hospitalists on the preventability of readmissions and the most important ways to prevent future readmissions. DESIGN AND MEASUREMENTS: A group of 17 hospitalists serving four community hospitals reviewed the details of 300 consecutive 21-day readmissions. Each used a structured data collection form to code information from inpatient and outpatient charts on patient characteristics, process measures, preventability, and potential interventions. RESULTS: Overall, 15% of readmissions were rated as overtly preventable, but with wide variation among hospitalists in their ratings of preventability. Perceptions of preventability appear to be a function of readmission timing, the similarity of diagnoses between admissions, medication issues, and the presence of certain chronic diseases (eg, chronic obstructive pulmonary disease [COPE]). Hospitalists were more likely to recommend familiar interventions under their control for a readmissions termed preventable, such as extending the initial hospital stay or addressing medications and patient education at discharge. They less often identified outpatient case management, home services, or physician nursing home visits as viable prevention strategies. CONCLUSIONS: The study points to the multifactorial nature of interventions needed to prevent readmissions, the tradeoffs between hospital length of stay and readmission, and the importance of fostering a culture of optimism and engagement to outpatient components of the health system to reduce hospital readmissions. Journal of Hospital Medicine 2011;6:383-388. (C) 2011 Society of Hospital Medicine