Dartmouth Atlas: Readmission Rates Show 'Not Much Progress'
Nancy Foster, Vice President for Quality and Patient Safety Policy for the American Hospital Association, said the AHA favors sharing good information that helps hospitals improve. But the data in this report, she says, "indicates that the challenges of reducing unnecessary readmissions are complex, and there's not one single solution."
Sometimes, she says, the problem is that the patient doesn't have a primary care physician, or maybe they have multiple physicians. "You can say that oh, the problem would be solved if the hospital makes an appointment for the patient in 14 days. It sounds simple, but it is not easy to do."
Sometimes she adds, the doctors are not accepting new patients, or they're overwhelmed, and it becomes very challenging to make sure it happens."
Reducing readmissions is a prominent goal throughout the healthcare industry, she added. "I can't point to one hospital that isn't working very hard on this," she said.
The Dartmouth report provided some examples of the extreme regional variation in readmission rates:
- Readmission rates after surgeries varied with 28 regions experiencing a decrease, most notably Elyria, Ohio which fell from 19% to 15.2% between 2004 and 2009, and White Plains, NY, where readmissions rose from 13% to 17.4%.
- Among patients who went to a hospital for medical treatment as opposed to surgery, Michigan had the highest rates, with 18.9% in Pontiac, 18% in Dearborn and 17.9% in Detroit while lower rates were in Utah, for example 13% in Provo and 13.6% in Salt Lake City. For surgical patients, rates ranged from 7.5% in Rapid City, SD to 19% in the Bronx, NY.
- High rates for one type of hospitalization, for example medical, surgical, heart attack or pneumonia, also had high readmission rates for the others, indicating "there may be common system-level factors within a region influencing readmission rates, independent of particular illnesses or chronic conditions," the report said.
The research project for the first time includes a companion report for patients with advice on how they should take a more active role in managing their own care to prevent a readmission.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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