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Revolving Door Of Readmissions and ED Visits More Extensive and Expensive

Cheryl Clark, for HealthLeaders Media, May 27, 2010

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.

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