Rethinking thirty-day hospital readmissions: Shorter intervals might be better indicators of quality of care

David L. Chin, Heejung Bang, Raj N. Manickam, Patrick S Romano

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Public reporting and payment programs in the United States have embraced thirty-day readmissions as an indicator of betweenhospital variation in the quality of care, despite limited evidence supporting this interval. We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospitallevel quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals' control. Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.

Original languageEnglish (US)
Pages (from-to)1867-1875
Number of pages9
JournalHealth Affairs
Volume35
Issue number10
DOIs
StatePublished - 2016

ASJC Scopus subject areas

  • Health Policy

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