What do re-admission rates measure?

Austin Frakt has a post on a paper noting that re-admission rates are not strongly correlated with mortality or process measures of quality of care.

At least some hospital re-admissions are related to problems with the long term care system available to patients; this reality should be added to the readmission mix, especially the discussion about what we are measuring, and what might be done about readmissions? Readmissions as imperfect measures of hospital quality became clear to me from the recent experience that my family has had in providing care to my mother-in-law. The short version is that she was admitted to the hospital 3 times in 40 days in late 2012-early 2013, and all of them were directly related to long term care issues, particularly our inability to successfully deal with wandering in a person with  escalating dementia, but who retained fairly robust lower-body mobility. The readmissions had little to do with the hospital in question, if anything at all.

One note however. A key 3 minute conversation between my wife, myself and a hospital social worker during the last inpatient stay was very important. After the first two admissions, my wife was asked by soical workers/discharge planner types: “can you safely care for your mother at home?” During the last admission, the social worker said: “it is obvious to me that you can no longer care for your mother safely at home” which in many ways “allowed” my wife to say that we had to seek institutional long term care, which we did. In any event, expansion to include the long term care system should be added to the discussion of readmissions as measures of “hospital quality.”

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to What do re-admission rates measure?

  1. Matthew says:

    I think you are taking Austin Frakt’s critique a bit too lightly. The question isn’t so much “what are we measuring with readmission rates”–we know exactly what we are measuring–but rather, the question is whether hospital readmission rates are a useful proxy measure of anything important at all. And I think the conclusion from the evidence presented in Frakt’s post and elsewhere is no. As far as I can tell, the only thing readmission rates are indicative of is how far a drive it is to the hospital: http://theincidentaleconomist.com/wordpress/chart-of-the-day-geographic-variation-in-medicare-hospital-readmission-rates/

    I don’t even see a theoretical reason why readmission rates would be a good proxy for hospital quality. As a thought experiment, the worst possible quality hospital is one where all the patients die–it would have a readmission rate of zero.

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