Some Surprises in Hospital Readmission Rates

Cardiosource WorldNews – A new statistical brief from the Agency for Healthcare Research and Quality can provide a base for comparison when evaluating 30-day readmission rates for specific groups and conditions.

Not really a surprise: Readmission rates following a hospital stay for a chronic condition, such as heart failure or diabetes, can be substantially higher than for an acute condition like pneumonia or a myocardial infarction. 

What does seem surprising is this: For patients age 65 and older covered by Medicare, the 30-day readmission rate following surgical hospitalizations was lower for chronic conditions than for acute conditions (14.3% versus 17.0%). This is different from the patterns observed in other age and payer groups, where the 30-day readmission rate following surgical hospitalizations was reported to be similar or even higher for chronic conditions.

HCUP Data
The data were reported March 13, 2012 in a release from the Healthcare Cost and Utilization Project (HCUP). The numbers covered patient data from 2008 and 15 states that are geographically dispersed and account for 42% of the total U.S. population.

Data were derived from nearly 1.7 million surgical hospitalization discharges and 2.9 million non-surgical hospitalization discharges.  Overall 30-day readmission rates (covering pediatric, adult and elderly patients with either private or Medicaid/Medicare coverage) were:

  • 12.6% for surgical hospitalization for chronic conditions versus
  • 12.5% for surgical hospitalization for acute conditions

and

  • 22.7% for non-surgical hospitalizations for chronic conditions versus
  • 18.0% for non-surgical hospitalizations for acute conditions

Consistently, 30-day readmission rates for non-surgical hospitalizations for chronic conditions were higher than the readmission rates for acute conditions, and this was true regardless of payer or age group.

To give an example of the data were analyzed, a patient with a principal diagnosis of chronic heart failure who was hospitalized and underwent cardiac defibrillator implantation was classified as having a surgical hospitalization for a chronic condition; yet the same patient without an operating room procedure would have been classified as having a non-surgical hospitalization for a chronic condition.

Key Findings

  • For children aged 1–17, the 30-day readmission rate was two times higher when the initial stay was for treating a chronic condition as opposed to an acute condition, regardless of whether or not the initial stay involved surgical treatment.
  • For privately-insured adults, ages 45 to 64 years old, the 30-day readmission rate following surgical hospitalizations was similar across chronic and acute conditions.
  • In 2008, 1 in 8 surgical hospitalizations resulted in a readmission within 30 days across all payer and age groups.
  • In 2008, 1 in 5 non-surgical hospitalizations resulted in a readmission within 30 days across all payer and age groups.
  • The 30-day readmission rates for privately-insured adults were consistently lower than adults covered by Medicaid, regardless of age group.

Source: Podulka, J. (Thomson Reuters), Barrett, M. (Thomson Reuters), Jiang, H.J. (AHRQ), and Steiner, C. (AHRQ). 30-Day Readmissions following Hospitalizations for Chronic vs. Acute Conditions, 2008. HCUP Statistical Brief #127. February 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb127.pdf

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Myocardial Infarction, Operating Rooms, Pneumonia, Patient Readmission, Medicaid, Heart Failure, Hospitalization, Diabetes Mellitus


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