The focus on 30-day readmissions rates could be misguided, according to new research from Beth Israel Deaconess Medical Center (BIDMC).
In an effort to improve the quality of care and lower costs, Medicare’s mandatory 30-day readmissions reduction program imposes penalties on healthcare providers for excess readmissions within 30 days of discharge. Providers are using complex IT systems to track and lower rates across their populations.
However, according to the researchers at BIDMC, 30-day readmissions rates do not reflecting changing risk factors. Instead, the researchers recommend two distinct 8-day and 30-day readmissions rates to measure quality.
The researchers reviewed than 13,000 discharges involving more than 8,000 patients in 2009 and 2010. They found that post discharge between 0-7 days was associated with factors of acute illness managed during initial hospitalization. The pateints' chronic illness only became a factor later on (8-30 days post discharge). There were also differences in the specific time patients were discharged. When discharged 8 a.m. and 12:59 p.m., patients fared better with more access to resources, such as pharmacies, during that day.
"Our research found that risk factors for readmission evolved during the first 30 days following hospital discharge," stated lead author Kelly L. Graham, M.D., a physician in the Division of General Medicine and Primary Care at BIDMC. "Readmissions in the first week were more highly associated with factors related to the initial hospitalization than later readmissions. These findings suggest that the standard 30-day metric does not accurately reflect hospitals' accountability for readmissions."
The researchers also looked at the social determinants that impact readmissions rates. Low health literacy was associated with early and late readmissions. They determined that hospital and outpatient settings both need systems to monitor patients as they go from the hospital to primary care.
This is not the first study that takes aim at the 30-day readmissions mandate. In February, the Chicago-based Northwestern Medicine and the American College of Surgeons released a study that said penalizing hospitals for high readmissions rates was not the path toward improved quality of care.