Study Shows Majority of Unplanned VA Hospital Readmissions Unrelated to Index Hospitalization
Hospital readmissions are increasingly used for public reporting and pay-for-performance; moreover, the Centers for Medicare and Medicaid Services, as well as VA publicly report 30-day readmission rates for three medical conditions: heart failure (HF), pneumonia (PNA), and acute myocardial infarction. Despite the use of readmissions as a performance measure, the extent to which medical or surgical readmissions reflect quality of care remains largely unknown and somewhat controversial. Therefore, this study examined unplanned VA hospital readmissions – and compared the leading reasons for unplanned readmission between medical and surgical discharges. Using VA administrative data, investigators identified all Veterans who were discharged after acute-care medical or surgical hospitalizations at VA hospitals from FY03 through FY07 (n=2,332,796). The main outcome was unplanned readmission within 30 days. Investigators also identified leading reasons for unplanned hospital readmissions for medical (81%) and surgical (19%) index discharges and applied a validated algorithm using admission diagnostic codes to determine whether the cause of readmission was clinically related or unrelated to the index hospitalization.
- After excluding planned readmissions, 12% of all discharges were followed by an unplanned readmission within 30 days.
- Although nearly 42% of unplanned readmissions were identified as clinically related, the majority of unplanned VA hospital readmissions were unrelated to the index hospitalization for both surgical and medical discharges.
- The top five reasons for hospital readmission among medical discharges included: non-hypertensive heart failure (HF; 8%), pneumonia (5%), chronic obstructive pulmonary disease (5%), urinary tract infections (UTI, 3%), and fluid and electrolyte disorders (3%). Among surgical discharges, complications of surgical procedures or medical care (22%) or devices (7%) accounted for nearly 75% of the top five reasons for readmissions; the remaining three included HF, UTI, and pneumonia.
- The extent to which identified clinically related unplanned readmissions were preventable remains unclear due to the use of administrative data. Relying on administrative data rather than chart review may also miss some clinically related causes of readmission, including some surgical complications.
- Medicare data were not used, thus readmission rates may have been underestimated.
- These findings suggest that most hospital readmissions might reflect clinical and social factors, including the severity of the patient's condition, inadequate social support, or post-discharge factors (e.g., lack of coordination between inpatient and outpatient settings). Thus, quality improvement interventions should target those processes of care that may decrease related risks.
Rosen A, Chen Q, Shin M, et al. Medical and Surgical Readmissions in the Veterans Health Administration: What Proportion are Related to the Index Hospitalization? Medical Care, “Brief Report.” March 2014;52(3):243-249.