Hospital readmissions are mainly due to inadequate follow-up
care, according to over half of the respondents to a recent ACP Internist survey.
We asked readers what they felt was the primary driver
behind hospital readmissions: inadequate discharge instructions, inadequate
follow-up care, stressful hospital experience, the fact that the patient is at
the end of life, or other. One hundred sixty-two of 290 respondents, or 55.86%,
said that hospital readmissions are due mainly to inadequate follow-up. Inadequate
discharge instructions was the next most popular response, with 27.93%,
followed by "patient is at the end of life" with 11.03% and "stressful
hospital experience" with 1.38%.
Eleven respondents, or 3.79%, reported that other reasons
were responsible, including patient nonadherence, lack of resources to obtain
medications, lack of a primary care physician, premature discharge and physician
error.
Thirty-day readmission rates have been a focus of concern in recent years. CMS publicly reports readmission rates for several conditions on
its Hospital Compare website, and its Readmissions Reduction Program has begun financially penalizing
hospitals with excess readmissions as of discharges on or after Oct. 1, 2012.
Earlier this year, Harlan M. Krumholz, MD, put a new spin on
the topic in a New England Journal of Medicine
perspective. In the article, he suggested that clinicians might be focusing too
much on the acute cause of a patient's hospitalization when trying to hold down
readmission rates. Instead, he said, they should also consider the "acquired,
transient period of vulnerability" that occurs after hospital discharge. Dr. Krumholz recommended that physicians begin trying to identify and reduce other
factors, such as pain, inadequate sleep and poor nutrition, that may make patients
more likely to be readmitted.
For more on this topic, read ACP Hospitalist's March 2013 cover story, "Post-hospital
syndrome: Could a new diagnosis help fix readmissions?"
Blog | Monday, April 1, 2013
