Study Assesses Trends in Readmissions and Use of Observation Units

Readmission rates for both targeted and non-targeted conditions are decreasing, and changes in observation-unit stays did not account for the decrease in readmissions. These trends are consistent with hospitals’ responding to incentives to reduce readmissions, including financial penalties for readmissions, according to a study published Feb. 24 in the New England Journal of Medicine.

Rachael B. Zuckerman, MPH, the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC, et al., looked at monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 – May 2015 at 3,387 hospitals.

Results showed that readmission rates for targeted conditions – acute myocardial infarction, heart failure and pneumonia – declined from 21.5 percent to 17.8 percent, while rates from non-targeted conditions declined from 15.3 percent to 13.1 percent. Further, Zuckerman, et al., found that rates began to fall faster in April 2010, after the passage of the Affordable Care Act (ACA), and continued to decline at a slower rate.

They also found that the rate of observation-service use for targeted and non-targeted conditions increased throughout the study period, but there was “no significant association” within hospitals between increases in observation service use and reductions in readmission.

The authors conclude that the change in rate of readmissions suggests that the Hospital Readmissions Reduction Program, which is included in the ACA, “may have had a broad effect on care, especially for targeted conditions.” The authors add that moving forward, “given the change in patterns of care during the analysis period, it will be important to continue monitoring these trends.”

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Aged, Heart Failure, Medicare, Myocardial Infarction, Patient Discharge, Patient Protection and Affordable Care Act, Patient Readmission, Pneumonia, United States Dept. of Health and Human Services

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