Community factors may be tied to hospital readmissions

Community factors may be linked to hospital readmission rates, according to a study published in Health Services Research.

Researchers of the Health Research & Educational Trust in Chicago and the Yale University School of Medicine in New Haven, Conn., examined 4,073 hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction, heart failure, or pneumonia. They linked these to publicly available county data from the Area Resource File, the Census, NursingHome Compare, and the Neilsen PopFacts datasets.

Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.

“This information is pertinent to any medical professional,” according to Eric Heil, cofounder, president & CEO of RightCare, a Horsham, Pa.-based medical technology company focused on reducing readmissions, improving quality of care, and reducing healthcare costs. Heil was not involved in the study.

“In the past few years, there has been a major shift toward improving quality of care for patients by focusing on patient clinical factors,” Heil said. “While this remains critical to healthcare providers, it is not the driving factor behind readmissions. Anyone involved throughout the continuum of healthcare must now consider how the location of their facility affects readmissions levels. With the number of newly insured Americans who have never had access to a number of prescription drugs or medical services, hospitals in low-income areas may experience substantial increases in admissions and prescriptions, which will ultimately lead to increased readmission rates, and medication non-adherence.”  

Formulary managers, and all other healthcare professionals should continue striving to make improvements in quality of care and following up post-discharge, however it is vital to allocate resources and time toward integrating social reform and community-based programs, according to Heil.

“By implementing safety-net programs and working with the community to help teach proper drug compliance and post-care measures, it will help alleviate some of the risk associated with low-income patients, in turn, lowering readmission rates for hospitals and improving medication adherence rates,” he said.

A specific diagnosis or medical condition is less of a contributing factor to poor health outcomes than initially anticipated when it comes to readmission risk, according to Heil.

“While it is still important for formulary managers to be involved in drug management throughout the continuum of care, it’s not just the follow up that’s important, but educating patients prior to the time of discharge, especially newly insured Americans who have never had access to prescription drugs, on how to properly manage and adhere to medications, and the consequences that result from poor adherence,” he said.