A controversial JAMA study faces a rebuttal from a researcher who believes readmissions policy has worked largely as intended, with no linkage between lower readmissions and higher mortality.
A study that links lower hospital readmission rates higher mortality among heart failure patients is being challenged.
The study, which appeared this week in JAMA Cardiology, estimates that as many as 10,000 heart failure patients could die prematurely each year because of well-intended but misguided efforts that keep them out of the hospital to avoid the financial penalties attached to higher readmissions.
The findings flatly contradict a July study in JAMA that reviewed more than six million hospitalizations and showed no linkage between reduced 30-day readmissions and increased post-discharge mortality.
Kumar Dharmarajan, MD, chief science officer at Clover Health and lead author of the July JAMA study, spoke with HealthLeaders Media about the conflicting conclusions. The following is an edited transcript.
HLM: These two studies attempt to answer the same question, but come up with the opposite answers. How is that possible?
Dharmarajan: Their study – and I say this with respect – is technically limited for a few reasons.
What they did, essentially, is look at 30-day readmission rates and 30-day mortality rates over time. The problem with that is, just because two things are changing over time, it’s hard to know if they’re related. As a dumb example, in the summer people swim more and eat more ice cream and there are more drownings. Does that mean ice cream causes drowning?
Their analysis is interesting, but they don’t go to the next level, which is what we did. The premise in our paper was that, if it is true that readmissions are causing greater mortality, we would expect to see that when we looked at trends, not just nationally, which is what they did, but within each hospital.
We looked at 4,000 or more hospitals in the United States caring for patients with heart failure. For each hospital we plotted that trend in readmission and mortality. If readmission declines are harming patients, we would expect to see that the hospitals with the greatest decrease in admissions would have the greatest increase in mortality. We found that there was no relationship. To the extent that there was a relationship, it was the opposite. Hospitals that were dropping readmission rates had mortality rates that were improving.
John Commins is a senior editor at HealthLeaders.