Another interesting article about the causes of readmissions and their prevention is in this month’s New England Journal of Medicine. This article (The Relationship between Hospital Admission Rates and Rehospitalizations) explores the causality for readmissions, and reports on the factors showing the highest correlation with the readmission rate. The authors found that the primary driver of the readmission rate was the overall “all-cause admission rate”, meaning that hospitals having high admission rates were also found to have high rates of readmissions(not just high NUMBERS of readmissions, which would be obvious, but high RATES of readmissions, which is the percentage of admissions that become readmissions). One interesting comment was that “Although some single-site efforts have reduce readmissions and the cost of care, there is little evidence that these sorts of clinical interventions can be delivered more broadly”, which suggests that successes in reducing readmissions may be more anecdotal than systematic. (For an interesting commentary on why anecdotal successes often don’t create systematic improvements, see Megan McArdle’s recent article on “Why Pilot Projects Fail”.)
The NEJM authors suggest that initiatives that reduce the overall rate of admissions, such as those embedded in accountable care organizations and medical homes (but not bundled payment initiatives, which have no incentive to reduce admission rates) will be more effective than efforts targeted at specifically reducing readmissions. These conclusions have been noted in other recent research papers described in this Single Tracks web article. Given that Medicare payments are increasingly affected by readmission rates, it will be incumbent on provider organizations to identify those techniques that can be implemented in their settings by their staff and that will have a high probability of success.