Quality surgical care is strongly linked to hospital readmission rates, according to a study from Harvard School of Public Health (HSPH), which appears in the New England Journal of Medicine.
Much of the policy focus in the past has been on reducing readmissions after hospitalization for medical conditions, such as heart failure and pneumonia, but this approach has been controversial. Readmissions for medical conditions are primarily driven by how sick the patients are and whether they live in poor or better-off communities; the link between hospital quality and readmissions is less clear. The study sought to find out if there was a relationship between readmission rates after surgery and the quality of surgical care in that hospital.
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 was composted 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 patients discharged 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 percent vs. 16.8 percent). Hospitals with the lowest surgical mortality rates had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3 percent vs. 14.2 percent).
The findings provide evidence of a strong relationship between surgical quality and readmissions and could encourage hospitals to focus on making surgical care better. To date, reducing hospital readmission rates has been an important clinical and policy priority, but whether those rates really measure the quality of hospital care hasn’t been clear, researchers find. The finding provides an opportunity for policymakers to improve surgical quality and decrease readmission costs and supports plans by CMS to expand its readmission penalty program to include surgical procedures.
Source: Harvard School of Public Health (HSPH), September 18, 2013
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