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Hospital Readmission Rates Linked With Quality of Surgical Care

Findings suggest way to reduce health care spending (Sept. 19)

Reducing hospital readmission rates is an important clinical and policy priority, but whether those rates really measure the quality of hospital care isn’t clear. In a new study, researchers at the Harvard School of Public Health found evidence of a relationship between surgical readmission rates and the quality of surgical care.

The findings provide an opportunity for policymakers to improve surgical quality and to decrease readmission costs, and supports plans by the Centers for Medicare and Medicaid Services to expand its readmission penalty program to include surgical procedures.

“Our findings suggest that focusing on surgical readmissions may be a smart policy approach to both improving care and reducing unnecessary spending,” said senior author Dr. Ashish Jha.

The new study appears in the Sept. 19 issue of the New England Journal of Medicine.

The researchers calculated 30-day readmission rates using Medicare data for six major surgical procedures: coronary-artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. The study cohort consisted of 479,471 discharged patients from 3,004 hospitals in the U.S. who underwent one of the six procedures.

The results showed that approximately one in seven discharged patients was readmitted within 30 days. Hospitals with the best performance on two well-established measures of hospital surgical quality — surgical volume and 30-day mortality rates — had much lower readmission rates than other hospitals. For example, hospitals in the highest quartile for surgical volume had a significantly lower readmission rate than hospitals in the lowest quartile (12.7% vs. 16.8%, respectively). Hospitals with the lowest surgical mortality rates had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3% vs. 14.2%, respectively).

According to the authors, the new findings provide evidence of a strong relationship between surgical quality and readmissions and could encourage hospitals to focus on making surgical care better.

“The findings are good news for policy makers and the public health community as a way to reduce health care spending and to improve outcomes for surgical patients,” said lead author Dr. Thomas Tsai.

Source: Harvard School of Public Health; September 19, 2013.

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