For readmitted patients whose index admission was for treatment of heart failure, pneumonia, or chronic obstructive pulmonary disease, the reason for readmission was not the same as the reason for their first admission for 63%, 71% and 64% of the time, respectively, he wrote.
But why, Krumholz asked. "How might the post-hospital syndrome emerge?"
Substantial stress during the experience of being a patient, he suggested.
"During hospitalization, patients are commonly deprived of sleep, experience disruption of normal circadian rhythms, are nourished poorly, have pain and discomfort, confront a baffling array of mentally challenging situations, receive medications that can alter cognition and physical function and become deconditioned by bed rest or inactivity," he wrote.
"Each of these perturbations can adversely affect health and contribute to substantial impairments during the early recovery period, an inability to fend off disease, and susceptibility to mental error."
Krumholz stresses that it's important for hospital transition teams to "ensure that the condition for which a patient was initially admitted is successfully treated," but that teams also need to focus on the early recovery period, during which discharged patients are most vulnerable.
He has given readmission prevention a lot of thought. His group has been contracted with the Centers for Medicare & Medicaid Services to examine certain algorithms and risk adjustments in the 30-day readmission penalty provisions of the Patient Protection and Affordable Care Act.