Readmissions linked to access

April 24, 2014

Measures of access to care explained almost half of variation in readmission by county

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

In the 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.

“In the past few years, there has been a major shift toward improving quality of care for patients by focusing on patient clinical factors,” according to Eric Heil, cofounder, president & CEO of RightCare, a Horsham, Pa.-based medical technology company focused on reducing readmissions. “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.”

According to the study authors, 58% of the total variation in publicly reported hospital 30-day readmission rates was attributable to the county where the hospital was located. In other words, the results suggest that individual hospital performance accounts for only 42% of the variation.

Healthcare professionals should continue striving to make improvements in following up post-discharge, however it is vital to allocate resources and time toward integrating social reform and community-based programs, according to Heil.

He says community programs can help alleviate some of the risk associated with low-income patients, in turn, lowering readmission rates for hospitals, so it’s a worthwhile investment. 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.

Education for patients prior to discharge, especially newly insured Americans, should include instruction on how to properly manage and adhere to medications as well as the consequences that result from poor adherence, he says.

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.