July 19, 2017
Recent research in JAMA found that reducing hospital readmission rates is not associated with an increased risk for death.
“Significant reductions have occurred in 30-day readmission rates for US Medicare beneficiaries since passage of the Affordable Care Act,” Kumar Dharmarajan, MD, Assistant Professor of Medicine at Yale School of Medicine, and colleagues wrote. “Whether hospitals’ increased focus on lowering readmissions produced unintended consequences, particularly increased mortality after hospitalization, is unknown. Researchers and advocacy groups have raised concerns that hospitals, wary of financial penalties, might deter the readmission of patients requiring inpatient care, thereby increasing mortality after discharge. However, strategies designed to lower readmissions through improved hospital, transitional, and postacutecare may have instead reduced both readmission and mortality rates following hospitalization.”
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In order to determine how readmission reductions since implementation of the ACA have impacted mortality rates, the researchers conducted a retrospective review of 2,962,554 Medicare beneficiaries aged 65 years and older who were hospitalized with heart failure, acute myocardial infarction, and pneumonia between 2008 and 2014. They compared 30-day readmission rates and 30-day mortality rates after discharge for each study month at each of the approximately 5000 study hospitals.
Study results showed that not only did reducing readmissions not increase 30-day mortality rates, the reduction was also associated with a slight reduction in mortality.
“Among Medicare fee-for-service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge,” Dr Dharmarajan and colleagues concluded. “These findings do not support increasing postdischarge mortality related to reducing hospital readmissions.”
In a related editorial, Karen E Joynt Maddox, MD, MPH, of the Harvard TH Chan School of Public Health, lauded the findings of Dr Dharmarajan and colleagues.
“This is certainly good news,” she wrote. “There is an emerging literature on strategies that hospitals are using to reduce readmissions, the majority of which relate to improving coordination, communication, and cooperation among physicians and other health care professionals and across care settings. These strategies are patient centered and, when successful, should be adopted by all hospitals, regardless of baseline readmission rates. The fact that these strategies do not inadvertently increase mortality rates, and may even have some positive effects, is even more reason to continue this important work helping patients transition safely from hospital to home.”
The researchers noted that focusing on only three conditions was a limitation of the study findings, making extrapolation of this data to the overall hospitalized patients population limited.