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?"