|Authors: Krumholz HM et al. N Engl J Med 2017 Sep 14.
Hospital quality contributes to readmission rates, independent of patient factors.
Readmission rates are a common measure of hospital quality. Concerns have been raised that national readmission measures might reflect differences in unmeasured factors, such as patients’ social welfare or educational levels, rather than hospital performance.
To determine whether hospital features contribute to readmission risk, independent of patient factors, researchers identified >7 million Medicare patient admissions in 2014 and 2015. Half the sample was used to classify admitting hospitals into risk-standardized quartiles of 30-day readmission performance; the median readmission rate was 15.5%. From the other half of the sample, the investigators identified >37,000 patients, each of whom had two admissions for similar diagnoses at two hospitals in different quartiles. When the same patient was admitted both to a hospital in the best-performing quartile and to a hospital in the worst-performing quartile during the same year, risk for readmission was 2 percentage points higher after discharge from the worst-performing hospital.