A new database covering hospitals in 12 states shows the problem of readmissions and use of emergency room resources is more problematic than originally thought, according to a report from the Agency for Healthcare Research and Quality.
About four in 10 patients who sought acute care between 2006 and 2007 made multiple visits to the hospital either for an inpatient stay or an emergency visit or both.
"Most readmission studies only report information on patients who have multiple hospital inpatient stays," the AHRQ report says. "They exclude patients who sought care in the ED." By including emergency department utilization, the researchers discovered that the rate of multiple visits was increased by more than one-third, from an average of 1.5 to 2.1 acute care hospital visits per patient.
Among Medicare patients, 42% experienced multiple hospital admission and 38% multiple emergency visits.
The database includes 27.8 million inpatient stays, or 15.1 million patients. "More than a quarter of these patients, or 27.2% had multiple inpatient stays in the two years, with an average of 1.5 stays per patient."
The report is one of numerous studies underway to determine the extent to which patients are treated and discharged, but then are readmitted for care for the same illnesses, which not only strains healthcare resources. In many cases they may be avoided with closer care and monitoring after the patient goes home.
"Devising effective strategies to reduce the rate of multiple acute care hospital visits by the same person requires a thorough understanding of the factors that contribute to repeat visits," the AHRQ report says.
Importantly, the study revealed that patients living in the poorest communities had similar readmission rates compared to those living in the wealthiest communities, about 1.5 stays per patient.
The report also isolated readmission rates by selected condition categories. For example, 35.1% of patients with hardening of the arteries (coronary atherosclerosis) had multiple inpatient stays over the two-year period while 20.8% of patients with asthma had multiple inpatient stays.
Of patients with diabetes, 30.3% had multiple inpatient stays while the average was 28.2% of patients with high blood pressure. Average number of inpatient stays per patient ranged between 1.4 (asthma) and 1.7 (coronary atherosclerosis).
Looking at the same patients, 21.5% of those with hardening of the arteries, 23.4% of those with hypertension, 23.6% of those with asthma, and 27.9% of those with simple diabetes (without complications) had multiple visits to the emergency department, with an average number of trips ranging between 1.4 and 1.6.
The database sorted patients by payer source. Medicare beneficiaries had the highest rate of readmissions as inpatients, but Medicaid had the highest number of emergency department visits.
The report was issued as part of AHRQ's Healthcare Cost and Utilization Project and covered Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee, and Utah. The readmission and emergency room utilization rates were not separated by state.