• The new Dartmouth Atlas report on hospital readmissions

    The need for broad improvements in systems of care, of which discharge planning and care coordination are only two components, is evident in the strong association found between general health system factors and readmission rates. We found a robust relationship between regional inpatient intensity of care provided to Medicare beneficiaries and the risk of readmission; that is, in places where there was a greater tendency to use hospitals as the site of care, patients were more likely to be readmitted, irrespective of illness levels. This confirms other research underscoring the importance of primary care systems in reducing avoidable hospitalizations and the influence of local bed supply on overall admission rates. When a readmission is prevented, is the bed unfilled, or is it filled with another patient? If so, could that patient be cared for better and with less cost outside of the hospital? Under current payment models and care systems, the incentive is to fill the bed. In the absence of other interventions, reducing readmission rates may have no impact on total per capita inpatient days and costs within a community. This underscores the importance of aligning efforts to reduce avoidable readmissions with other policy and payment initiatives, such as global payments and accountable care organizations. Efforts to monitor improvements in care coordination and transitions need to be coupled with broader surveillance of patient populations and cohorts, so that the promise of better care for patients leaving the hospital is also reflected in improved outcomes and lower costs for the population as a whole.

    Links to the report and an interactive map are here.

    @afrakt

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    • The conclusions–capacity and willingness to readmit–could be answered by examining % occupancy rates trended over time, particularly in high utilization HRRs. Won’t answer causation question, but if associations present, would add to knowledge base.

      The Dartmouth folks raise the possibility of the filled bed hypothesis, provocatively so, but only on conjecture. I did not see any evidence in the report to make the insinuation.

      More likely in my mind, hospitals with higher hospital utilization rates perform poorly in transitions domain (or situate in communities with stretched resources)., Readmit % does not reflect an overt strategy to readmit and churn–although may play a role, albeit a smaller one–but has more subtle etiology rooted in clinical and community care delivery.

      Brad