Readmissions frequent, one-quarter related to new problem

Rates and causes of hospital readmissions, and the infrequency of follow-up care, were quantified in a new research brief from the National Institute for Health Care Reform.

About a third of adults discharged from the hospital were rehospitalized within one year, according to the brief, which used data from the 2000-2008 Medical Expenditure Panel Survey Household Component. The 5,805 participants, all with at least one overnight hospital stay, underwent five rounds of interviews covering their insurance and health status and health care utilization and expenditures.

Overall, 8.2% of the participants were readmitted within 30 days. More than a quarter of those readmissions (26.1%) were for conditions unrelated to the cause of their initial admission. When the analysis was extended to all readmission within a year, the percentage of admissions unrelated to the original one was 37.4%. This finding could be explained by patients not receiving adequate treatment for all their comorbidities, the researchers suggested.

The study also found that one-third of the patients did not see an outpatient clinician for follow-up within 30 days after discharge. About 7% of patients visited an emergency department within 30 days of discharge, and this statistic was approximately the same among both patients who did have a follow-up appointment and those who didn't. The study did find that patients who didn't follow up tended to be healthier and younger. There were no significant differences in follow-up rates associated with patients' type of insurance, despite the fact that patients with public insurance were typically sicker, researchers noted.

Private insurance paid for 47% of the 30-day readmissions, while Medicare paid for 40%. This statistic is interesting because more focus has been placed on changing Medicare policy to decrease readmissions, the researchers noted. The authors also discussed how other proposed health care reforms could potentially improve readmission and follow-up rates, including bundled payments, patient-centered medical homes and interoperative health information technology. They called for additional research on effective care for high-risk patients with multiple comorbidities.

The National Institute for Health Care Reform is a nonprofit organization established by the International Union UAW, Chrysler Group LLC, Ford Motor Company and General Motors that contracts with the Center for Studying Health System Change to conduct health policy research.