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Enumah SJ, Resnick AS, Chang DC. PLOS ONE. 2022;17:e0266696.
While quality and patient safety initiatives are implemented to improve patient outcomes, they also typically include a financial cost which must be balanced with expected outcomes. This study compared hospitals’ financial performance (i.e., financial margin and risk of financial distress) and outcomes (i.e., 30-day readmission rates, patient safety indicator-90 (PSI-90)) using data from the American Hospital Association and Hospital Compare. Hospitals in the best quintiles of readmission rates and PSI-90 scores had higher operating margins compared to the lowest rated hospitals.
Muchiri S, Azadeh-Fard N, Pakdil F. J Patient Saf. 2022;18:237-244.
The Hospital Readmissions Reduction Program (HRRP), implemented by the Centers for Medicare & Medicaid Services (CMS), imposes a financial penalty on hospitals with higher than average readmission rates for certain conditions. Six years of readmission rates for four conditions included in the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, and pneumonia) and two conditions not included (septicemia and mood disorders) were analyzed to assess the impact of the HRRP. The researchers conclude the HRRP reduced readmission rates for the four targeted conditions, but reductions were not consistent across all categories of patients.
Ziedan E, Kaestner R. Eval Rev. 2021;45:359-411.
The Centers of Medicare & Medicaid Service (CMS) Hospital Readmissions and Reduction Program (HRRP) financially penalizes hospitals if patients with certain medical conditions are readmitted. This study analyzed the empirical approaches used in prior research to evaluate the effectiveness of the HRRP. The authors conclude that approaches used in some prior research lacked internal validity and may not indicate causal consequences of the program on readmissions.
McHugh MD, Aiken LH, Sloane DM, et al. The Lancet. 2021;397:1905-1913.
While research shows that better nurse staffing ratios are associated with improved patient outcomes, policies setting minimum nurse-to-patient ratios in hospitals are rarely implemented. In 2016, select Queensland (Australia) hospitals implemented minimum nurse staffing ratios. Compared to hospitals that did not implement minimum nurse staffing ratios, length of stay, mortality, and readmission rates were significantly lower in intervention hospitals, providing evidence, once again, that minimum staffing ratios can improve patient outcomes. 

The Patient Safe-D(ischarge) program used standardized tools to educate patients about their discharge needs, test understanding of those needs, and improve medication reconciliation at admission and discharge. A quasi-randomized controlled trial of the program found that it significantly increased patients' understanding and knowledge of their diagnoses, treatment, and required follow-up care.

Weir DL, Motulsky A, Abrahamowicz M, et al. Health Serv Res. 2020.
This study examined the effect of medication regimen changes at hospital discharge on adherence and adverse events among older adults. At 30-days post-discharge, nearly half of patients were nonadherent to at least one medication change, 26% visited the emergency department, 6% were readmitted to the hospital, and 0.5% died. Patients who were non-adherent to all medication changes had a 35% higher risk of adverse events within 30-days post-discharge compared to those were adherent to all changes.
Hochman M, Bourgoin A, Saluja S, et al. Rockville, MD: Agency for Healthcare Research and Quality; March 2019. AHRQ Publication No. 18(19)-0055-EF.
Programs are in place to address hospital discharge process gaps that contribute to readmissions. This report summarizes research on primary care perspectives on reducing readmissions. Interventions identified include automated alerting to primary care providers when patients are hospitalized and the patient-centered medical home model.