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Weak Link Found Between Readmissions, Mortality

Cheryl Clark, for HealthLeaders Media, February 13, 2013

Hospital and policy leaders who complain that federal penalties for higher 30-day readmissions may have the unintended consequence of leading to more patient deaths, or that liberal readmissions practices actually prevent mortality, are largely incorrect.

That's the conclusion from Yale University School of Medicine readmission expert Harlan Krumholz, MD, and colleagues, as reported in Wednesday's Journal of the American Medical Association.

"Some researchers have raised concerns that hospital mortality rates and readmission rates might have an inverse relationship, such that hospitals with lower mortality rates are more likely to have higher readmission rates," Krumholz and colleagues wrote. "Interventions that improve mortality might also increase readmission rates by resulting in a higher-risk group being discharged from the hospital."

Additionally, there have been concerns that measuring either readmissions or measuring mortality means measuring basic quality of care, and that measuring both would be redundant.

And there are concerns that readmissions "could be 'adversely' affected by a competing risk of death—a patient who dies during the index episode of care can never be readmitted," wrote Eiran Z. Gorodeski, MD, and colleagues in a 2010 article in the New England Journal of Medicine.

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