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Hospital-readmission risk--isolating hospital effects from patient effects.

Krumholz HM, Wang K, Lin Z, et al. N Engl J Med. 2017;377:1055-1064.

September 20, 2017
Krumholz HM, Wang K, Lin Z, et al. N Engl J Med. 2017;377(11):1055-1064.

Avoiding readmissions has been an important safety goal, especially since Medicare has implemented nonpayment policies. Patient factors like health literacy and access to outpatient follow-up care have been implicated in previous research on readmissions. In contrast, this study sought to determine whether hospital quality affects readmission rates. By examining patients with multiple admissions for the same diagnosis but at different hospitals, they were able to focus on the effect of the hospital alone. Hospitals were divided into four tiers based on their known overall rate of readmissions, and then investigators assessed whether a given patient was more or less likely to be readmitted based on these tiers. They found a higher likelihood of a given patient being readmitted at hospitals in the tier with the most readmissions compared to those hospitals in the lowest readmission tier. The authors conclude that hospital readmissions are in part due to hospital factors as well as individual factors. This finding suggests that targeting hospital safety practices could reduce readmissions.