This analysis makes me wonder how readmission rates in the U.S. compare to those in countries that have national health systems or national health insurance.
Would their readmission rates reflect better coordination of care once a person leaves the hospital? Are their primary care systems better designed to assist people with follow-up care? Do those countries have better systems for home care and caregiver support? Or is there less pressure on hospitals in other health systems to discharge people as quickly as we do?
I went looking for some data to see if I could do a quick comparison but only found newspaper references to data from 2007-08 on patients “readmitted as emergencies” within 28 days of discharge. These stories reported 546,354 people age 16+ who were readmitted in 2007-08, with a little more than 159,000 of them age 75+.
Since I don’t know what their denominator is or what their criteria for readmission are, I couldn’t do a true comparison. But the Dartmouth Atlas data reported that roughly 523,000 out of 3.2 million Medicare beneficiaries in the US were readmitted. And I have to imagine that more than 3.2 million people in the UK who are 16+ were admitted to the hospital at some point during 2007-08.
Apples and oranges, I know. But it's still food for thought.
I had the same question that Lidia had: what about other countries? It seems as readmission rates are strikingly consistent across the US. And from the article we know that at least care coordination varies greatly across the regions (with less than 20% PCP visits in Manhattan to more than 60% at Mayo Clinic). Why don’t we see such variation in readmission rates? Is 15-17% readmission rate is almost what is expected? What would be the number to strive for? Another matter that was not clear to me was why hospitals are the ones to be penalized? There are 2 variables named in the article that are responsible for the high readmission rates: discharge planning and care coordination. As far as discharge – hospitals are tight down with minimal amount of days per the diagnosis and they often forced to discharge a patient earlier then doctors want to or patients feel comfortable to. And now they are penalized for doing it. I am not sure which one of these causes play greater role. But one way to look at care coordination would be to compare the time patients spend home after being discharged: the longer their stay is the more possibility then out-patient care is responsible for readmissions rather than hospitals.
While reading this I can't help but sympathize with the hospitals. Unfortunately, the Medicare population is a sick population.
Are these patients being readmitted for the same illnesses OR are they being readmitted for new illnesses that happen to surface shortly after their initial discharge?
Maybe elderly hospital admissions should be treated as addictions. When an individual leaves rehab, based on how well they've overcome the disease, assessed will to change, and environment at home, Doctor's recommend that the Addicts enter into a transitional sober living facility to continue to fight their addictions with the help and support of others.
For the elderly, they would be admitted into and optional transitional Home Care Rehab facility, where they are monitored closely to ensure that they are in fact ready to be out of the hospital.
Different from nursing homes, this facility would house patients for a week at a time. It is only a quick detour for those patients that are living at home.
This analysis makes me wonder how readmission rates in the U.S. compare to those in countries that have national health systems or national health insurance.
ReplyDeleteWould their readmission rates reflect better coordination of care once a person leaves the hospital? Are their primary care systems better designed to assist people with follow-up care? Do those countries have better systems for home care and caregiver support? Or is there less pressure on hospitals in other health systems to discharge people as quickly as we do?
I went looking for some data to see if I could do a quick comparison but only found newspaper references to data from 2007-08 on patients “readmitted as emergencies” within 28 days of discharge. These stories reported 546,354 people age 16+ who were readmitted in 2007-08, with a little more than 159,000 of them age 75+.
Since I don’t know what their denominator is or what their criteria for readmission are, I couldn’t do a true comparison. But the Dartmouth Atlas data reported that roughly 523,000 out of 3.2 million Medicare beneficiaries in the US were readmitted. And I have to imagine that more than 3.2 million people in the UK who are 16+ were admitted to the hospital at some point during 2007-08.
Apples and oranges, I know. But it's still food for thought.
I had the same question that Lidia had: what about other countries? It seems as readmission rates are strikingly consistent across the US. And from the article we know that at least care coordination varies greatly across the regions (with less than 20% PCP visits in Manhattan to more than 60% at Mayo Clinic). Why don’t we see such variation in readmission rates? Is 15-17% readmission rate is almost what is expected? What would be the number to strive for?
ReplyDeleteAnother matter that was not clear to me was why hospitals are the ones to be penalized? There are 2 variables named in the article that are responsible for the high readmission rates: discharge planning and care coordination. As far as discharge – hospitals are tight down with minimal amount of days per the diagnosis and they often forced to discharge a patient earlier then doctors want to or patients feel comfortable to. And now they are penalized for doing it. I am not sure which one of these causes play greater role. But one way to look at care coordination would be to compare the time patients spend home after being discharged: the longer their stay is the more possibility then out-patient care is responsible for readmissions rather than hospitals.
While reading this I can't help but sympathize with the hospitals. Unfortunately, the Medicare population is a sick population.
ReplyDeleteAre these patients being readmitted for the same illnesses OR are they being readmitted for new illnesses that happen to surface shortly after their initial discharge?
Maybe elderly hospital admissions should be treated as addictions. When an individual leaves rehab, based on how well they've overcome the disease, assessed will to change, and environment at home, Doctor's recommend that the Addicts enter into a transitional sober living facility to continue to fight their addictions with the help and support of others.
For the elderly, they would be admitted into and optional transitional Home Care Rehab facility, where they are monitored closely to ensure that they are in fact ready to be out of the hospital.
Different from nursing homes, this facility would house patients for a week at a time. It is only a quick detour for those patients that are living at home.