Hospitals vs. outpatient clinics: Which causes more unplanned patient readmissions?

A major goal of hospitals is to prevent unplanned readmissions of patients after they are discharged -- reimbursement is stake, after all, as the Centers for Medicare and Medicaid Services penalized those who underperform in this area. 

It turn out that the preventability of readmissions changes over time: Readmissions within the first week after discharge are often preventable by the hospital, whereas later readmissions are more likely related to patients' difficulty accessing outpatient clinics, according to a new study.  

Since newly discharged patients are typically recovering from a serious medical condition, and managing other chronic conditions at the same time, there can be logistical challenges related to their recovery, the authors said. There's a need for hospitals and outpatient clinics to work together more seamlessly to see that patients can stay at home and manage these conditions.

For their study, published in the Annals of Internal Medicine, the researchers examined information on 822 general medicine patients readmitted to 10 academic medical centers. Overall, 36.2 percent of early readmissions -- versus 23 percent of late readmissions -- were deemed preventable. Hospitals were identified as better locations for preventing early readmissions, whereas outpatient clinics and home were better for preventing late readmissions.

Premature discharge, as well as problems with physician decision-making related to diagnosis and management during the initial hospitalization, were the likely causes of readmissions in the early period. More likely to be amenable to interventions outside the hospital, later readmissions were most often caused by factors over which the hospital has less direct control, such as monitoring and managing of symptoms after discharge by primary care clinicians, as well as end-of-life issues.

Taken together, the findings suggest that readmissions in the week after discharge are more preventable, and more likely to be caused by factors over which the hospital has direct control, than those later in the 30-day window. In the current healthcare system, however, unplanned readmissions within the 30 days after hospital discharge are considered uniformly preventable by hospitals, and thus hospitals are punished with financial penalties for these events.

The authors said interventions to improve outcomes after hospital discharge should engage the ambulatory care system, with attention to improving access to primary care. Hospitals, they said, should also be careful to not overemphasize reducing a patient's length of stay, which could hurt readmission metrics due to premature discharge.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com