What do hospital readmissions measure?

This is a huge question and many health system experts have strong opinions. I’m aware of some of those. Nevertheless, I’m going to withhold judgement as I begin to take a fresh look at the broad and voluminous hospital readmissions literature. (Previously I focused on much narrower psychiatric readmissions literature only.) There is no way I will cover the broader literature comprehensively, but I hope my sample is representative of the fundamental ideas and results.

Feel free to chime in, but know that many of my posts will be of the “research notebook” type. That means I won’t be working too hard to make them accessible. At some point, when I can say something coherent, I may write some things without acronyms and jargon. For now, expect a lot of raw quotes.

First up, Examining the Impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration: The Case of Readmissions, by Amy Rosen et al.

Our study has several important findings. First, our results are consistent with the literature suggesting the potential impact of safety-related events on increased risk of readmission and other outcomes.[4,8–11,22] Second, despite the relatively low prevalence of individual PSIs [Agency for Healthcare Research and Quality Patient Safety Indicator], index hospitalizations with selected PSIs had significantly higher readmission rates than those without PSIs. In some instances, the odds were almost double. Having multiple PSI events increased the odds even more. […]

Third, we found that the occurrence of any PSI event in the index hospitalization was reflected in the reason for readmission. In general, index hospitalizations with any prior PSI event had a greater likelihood of readmission for complications related to surgical or medical care or implanted devices, or for acute problems such as infections that might be hospital acquired, compared with those without any prior PSI event. It is noteworthy that index hospitalizations without any prior PSI event were likely to be readmitted for exacerbations of chronic conditions, such as HF. […]

Index hospitalizations with PSIs reflecting continuity of care had a higher likelihood of being readmitted than hospitalizations that did not have these PSIs. This composite comprises the same PSIs that had the greatest impact on likelihood of readmission in Encinosa and Hellinger’s[10] study, providing further empirical support for the validity of this composite construction. As readmissions are sometimes thought of as “missed opportunities to better coordinate care,”[19] our results provide additional evidence that interventions to improve coordination of care across inpatient settings and between the inpatient and outpatient settings are important in reducing readmission rates.[36–38]

Does this validate rehospitalization rate as an outcome measure or PSIs as quality measures or both?


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