In a general hospital setting, early readmissions are more preventable and responsive to hospital-based intervention than late readmissions, which may be more responsive to ambulatory and home-based mediations, according to a study published in the Annals of Internal Medicine.
Kelly L. Graham, MD, MPH, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, and associates conducted a prospective group analysis at 10 US academic medical centers to understand if hospital readmission after 7 days of discharge was more or less preventable than readmission after 8 to 30 days postdischarge.
A total of 822 adult patients were readmitted, and 2 physician adjudicators used structured surveys at each site to measure the preventability of each case.
Early and late readmissions were 36.2% and 23.0% preventable, respectively. The investigators reported that early readmissions were better prevented in hospitals than late admissions (47.2% vs 25.5%). Preventability was in favor of late readmission in outpatient clinics and home settings compared with early readmissions (15.2% vs 6.6% in clinics; 19.4% vs 14.0% in homes).
“We believe it is time to change the model for patient outcomes after hospital discharge to one that recognizes shared accountability for readmissions along the entire spectrum of care,” the authors concluded. “If this cannot be achieved in the short term, our findings suggest that a 7-day readmission window will more accurately capture preventable hospital readmissions.”
Graham KL, Auerbach AD, Schnipper JL, et al. Preventability of early vs late hospital readmissions in a national cohort of general medicine patients. [Published online May 1, 2018] Ann Intern Med. doi: 10.7326/M17-1724