Predicting and preventing readmissions

In 2011, the U.S. spent $41 billion on 30-day hospital readmissions, $17 billion of which was due to avoidable readmissions. As part of its Hospital Readmissions Reduction Program, CMS penalized 2,601 out of more than 3,400 hospitals subject to the program in the 2015 fiscal year. Facilities with excessively high readmissions have had their Medicare payments docked between 1% to 3%, with 38 hospitals receiving the maximum penalty last year.

The issue of preventable hospital readmissions was the topic of two different studies published in The Journal of the American Medical Association this month. The studies looked at the main drivers of preventable readmissions and provided a tool for predicting which patients are higher readmission risks.

The first study looked into system flaws and gaps in care that could have been avoided with reasonable patient or physician activities. After examining 1,007 readmission cases across the country, researchers found that 27% of 30-day readmissions were preventable. Furthermore, 52% of readmission cases could’ve been prevented with “efforts made during the initial admission.”

The system study found that emergency department decision making and premature discharges were common factors behind preventable readmissions. The study also pointed to patients’ lack of awareness of who to contact after discharge and an inability to keep their follow-up appointments. To overcome this, researchers suggested that healthcare facilities look into:

•    Improving emergency department care coordination
•    Assisting patients in keeping post-discharge appointments
•    Improving disease monitoring
•    Reducing premature discharges from hospital
•    Ensuring patients know who to contact after discharge

The second study, conducted internationally, tests the effectiveness of a readmission prediction tool call the HOSPITAL score.  The acronym was created to identify the variables associated with 30-day hospital readmissions and stands for:

•    Hemoglobin level
•    Discharge from an Oncology service
•    Sodium level
•    Procedure during the index admission;
•    Index Type of admission (urgent)
•    Number of Admissions during the last 12 months
•    Length of stay

During the study, the HOSPITAL score categorized 62% of the patients as low risk, 24% as intermediate risk, and 14% as high risk for a potentially avoidable readmission. Those determined to be high risk using HOSPITAL were four times more likely to be readmitted within 30 days than low-risk patients.
Furthermore, potentially avoidable readmissions were predicted with a 72% accuracy with the HOSPITAL score, and the predicted probabilities of readmission in each risk category matched exactly the real observed proportion of readmission.

A blanket application of readmission interventions to everyone isn’t cost effective, researchers say, and incorporating the HOSPITAL score into the electronic health record can make sure that interventions are targeted at those who need them most.