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Are Hospital Readmissions a Valid Indicator of Quality of Care?

Hospitals and patients have an enormous stake in understanding the reasons for hospital readmissions. When a patient has been readmitted post-recovery or after a previous visit to the hospital, the initial concern is that the medical team failed to do their job.

As a result, healthcare providers, insurance companies and patients view hospital readmissions as a quality of healthcare services. But are readmissions due to a lack of quality of care by medical providers, or is the cause of readmissions a more complicated issue?

Costs of Readmission Rates

The main reason why readmissions are so detrimental to hospitals and health insurance companies is due to the overall cost of readmissions. This is primarily associated with an increase in health insurance costs, particularly for the Medicare and Medicaid programs. As a result, hospitals that have high rates of readmission are identified by the federal government. In fact, according to Kaiser Health News, more than half of the hospitals in the U.S. received readmissions penalties in 2016.  

There are also the financial costs doled out to medical facilities for patient readmissions. These are stacked on top of the added expenses to patients, private health insurance companies and medical providers for additional care.

However, regardless of the financial cost, readmissions to a hospital can also jeopardize the faith of the patient population and community being served. When patients are being readmitted and extending their time in treatment and recovery from an illness, chronic condition, trauma, or surgery they may lose trust in their care providers.

Conditions Leading to Hospital Readmissions

To better understand readmission rates, take a look at five indicators of hospital readmissions:

  • Being diagnosed with congestive heart failure
  • Having Medicare coverage
  • Discharge from the hospital after 1 p.m.
  • Low-income households
  • Lack of patient engagement

Additionally, Dr. Holly Felix, Associate Professor at Fay W. Boozman College of Public Health, poor coordination of care following discharge and poor follow-up care play a role in readmissions.

In a study published by Social Work Health Care, Dr. Felix’s research identified that men and patients with a low socioeconomic status were most likely to have a poor post-discharge experience. Also, of those patients surveyed in the study for follow-up care appointments, only 36 percent showed up for these appointments.

A look at all of the factors related to hospital readmission rates reveals a complex reality. A low socioeconomic status is a predictor of having a lack of resources for preventive health care, which can result in a lack of engagement and understanding in the importance of follow-up care.

Overall, however, these issues are not connected to the quality of care provided by a medical doctor or hospital staff. These issues are based on a societal structure that prevents patients from receiving post-care either through education, financial resources or access.

Hospital Readmissions as an Indicator for Quality of Healthcare

Furthermore, according to Claudia Fischer, a researcher at the Institute for Advanced Studies in Vienna, there is no reason to identify hospital readmissions as an indicator for quality of healthcare. In a study published in the Public Library of Science, Fischer states: “Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of the quality of hospital care is not evident.”

The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals and identifies readmissions in relation to quality of care. Yet the HRRP fails to consider several primary social determinants and factors. These include race and socioeconomic status, which are both associated with an increase in patient readmission rates. Patient demographics that are noted as disadvantaged or a minority are often overlooked in terms of quality of care indicators.

Patients who are from disadvantaged or low-income households have unique circumstances that ultimately cause readmission rates. Again, this is not due to the quality of care that the hospitals provide, but because of lack of access to the types of resources that could improve medical care outcomes.

Fischer states that more research is needed to identify the reasons for readmissions based on health conditions. This would further improve our understanding of whether hospital readmissions are a quality of healthcare issue.

In the meantime, hospitals have access to an increasing number of tools that can help reduce readmissions and improve quality of care. The PatientBond automated, digital patient engagement platform, for example, uses psychographic segmentation and adaptive technology to help hospitals and other healthcare providers manage discharged patients based on their own unique motivations and attitudes related to health and wellness. Through emails, text messages and Interactive Voice Response, PatientBond allows healthcare providers to extend their care beyond the walls of the practice.

Its use resulted in a more than 75 percent reduction in readmissions for a form of spinal surgery at a world-renowned New England hospital system, as well as a more than 90 percent reduction in readmissions for congestive heart failure at one of the largest nonprofit hospital systems in the U.S. Moreover, many of these CHF patients were from rural parts of Appalachia, with low health literacy and use of flip-phones instead of smartphones.   

Hospital readmissions are indeed a complex problem — but the solution doesn’t have to be.

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