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Revolving Door

Posted July 11, 2016

When patients leave the hospital, it’s best if they stay healthy enough that they don’t need to come back.

Hospital readmission rates are a key metric of health care quality, and improving those rates by making sure that as many patients as possible don’t need to return after discharge is a crucial part of many health reform efforts.

To keep readmission rates low, researchers have been trying to find out: Is there a way to predict which patients are most likely to return?

A new study led by Harvard Medical School researchers at Spaulding Rehabilitation Hospital points to nine characteristics that significantly increase the odds of medically complex patients being readmitted to acute care hospitals from inpatient rehabilitation facilities, including male gender, older age and poorer motor function at admission.

The results are published in the Journal of the American Medical Directors Association.

“This study builds on our growing understanding of hospital readmissions, with particular attention to the post-acute care setting,” said principal investigator Jeffrey Schneider, assistant professor of physical medicine and rehabilitation at Harvard Medical School and medical director of the Burn and Trauma Rehabilitation Program at Spaulding.

“Assessing individual hospitals’ readmission rates adds accountability to the healthcare system,” said Schneider. “However, it is important to make fair comparisons between institutions that account for the differences in populations that they care for.”

This study is one in a series Schneider and colleagues at Spaulding have conducted reviewing variables associated with hospital readmissions.

In the current study, the authors examined 16 patient and facility characteristics to identify which of those had a significant impact on readmission rates from inpatient rehabilitation facilities around the U.S. Forty-one percent of the variation in readmission rates was attributed to the nine most significant characteristics.

In addition to gender, age and individual motor function, the factors that correlated with readmission risk were higher comorbidity index, unemployed or retired status and longer duration of impairment for individual patients, plus some facility-wide characterstics: larger size of inpatient rehabilitation facility and poorer facility-wide motor function of all patients in the facility at the time of admission.

Further, the researchers found that facilities with the highest readmission rates tended to care for patients with the highest risk for readmission: unemployed male patients with higher comorbidity index and poorer motor function on admission.

The authors note that this finding suggests that the uneven distribution of at-risk patients needs to be taken into account when using readmission rates as a quality indicator for inpatient rehabilitation facilities.

“There is increasing scrutiny of readmissions to acute care from inpatient rehabilitation facilities, such as Spaulding,” Schneider said. “It does not make sense to hold all institutions accountable to the same readmission rate standards, without accounting for the demographic and medical factors that may predispose some populations to higher readmission risk.”

Lindsay Ramey, Richard Goldstein and Ross Zafonte of the Harvard Department of Physical Medicine & Rehabilitation at Spaulding; Colleen Ryan of Massachusetts General Hospital; and Lewis Kazis, professor of health law, policy and management at the Boston University School of Public Health were co-authors of this study.

Source: HMS

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