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A new study suggests that 10% of patients who receive coronary stents are readmitted within 30 days - and those readmitted are more likely to die within the following year.
The study also suggests that at least some of the factors related to readmission can't necessarily be changed by better care.
Still, researchers said the findings give hospitals a place to start in terms of addressing those extra risks and making sure each patient is discharged with the right tools to prevent another costly hospital stay.
Environment transition
"Many hospitals until recently have not focused on transitions to the outpatient environment," said Dr Adrian Hernandez, from the Duke University School of Medicine in Durham, N.C., who wrote a commentary published with the study in Archives of Internal Medicine.
"When a patient's leaving the hospital, it's really important for not just the patient but the family... to understand what they had done and what they need to know about the disease and their medication," Hernandez said.
The authors of the new study tracked close to 13 000 patients who had one or more elective or emergency stent procedures over a 10-year period at the Mayo Clinic in Rochester, Minnesota, US.
Readmission
Just under 10% of patients were readmitted within the month afterward for heart-related or other complications. Female gender, kidney and lung diseases, and cancer increased the risk of readmission by 30 to 90%.
Procedural complications such as bleeding and heart attacks, as well as a longer hospital stay, were boosted the odds of readmission.
Nearly 8% of patients who were readmitted died within a year - a rate 40% higher than among patients who were not readmitted.
The higher mortality among readmitted patients was probably because they were sicker to begin with, or because of hospital errors that may have led to their readmission in the first place, Hernandez told Reuters Health.
In the US, performance measures such as rehospitalisation of heart patients are being targeted as ways to financially reward the hospitals with better outcomes.
Rehospitalisation preventable
"Readmission rates have been publicly reported by Medicare and advocated as measures of care quality based on the presumption that many of these early rehospitalisations are preventable," said Dr Gregg Fonarow, a cardiologist at the David Geffen School of Medicine at the University of California, Los Angeles.
"This new study, however, shows that there are relatively few early rehospitalisations that are directly related to the (stent) procedure," added Fonarow, who wasn't involved in the research.
That doesn't mean a hospital's readmission rates aren't one fair way to assess its quality of care, argued one of the study's authors, Dr David Holmes, from the Mayo Clinic in Rochester.
"We're not going to change the fact that they're women, but we could then be on the lookout for things that might affect them," for example whether they're taking enough medications and the right ones, he told Reuters Health.
Holmes added that readmission numbers can provide clues to whether patients were sent home too early to begin with, how well doctors treated comorbidities, and how well patients were educated before discharge.
"As a quality indicator, I think that (rehospitalisation) is a very reasonable thing," Holmes said. But, "It does not answer all the questions."
Hernandez agreed that hospitals have to look at their readmission rates as one piece of the puzzle of providing patients better care, and that the new study can help them do that. - (Genevra Pittman/Reuters Health, November 2011)
SOURCE: http://bit.ly/vsmjmg
Arch Intern Med 2011.
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