Detailed review: Geographical location of hospitals. Boston :4.5 beds per thousand people. New Haven : 2.9 beds per thousand.
Division into cohorts Five cohorts:- myocardial infarction, stroke, gastrointestinal bleeding, curative surgery for lung, colon etc. Rate of admission for these illness are similar as physicians agree on the need to hospitalize.
Results Readmission rates in Boston were 1.64 times the readmission rates in New Haven.
Results Higher readmission rates were not related to length of stay. index admission :14.8 vs 13.5 days readmission :11.3 vs 11.2 days The mortality rate was similar at both places
Explanations? Severity of illness? Nursing home care vs inpatient care?
Results Association between availability of hospital beds and overall discharge rate. Possible explanation:- threshold of availability of beds plays a role in clinical decision making.
Solutions Weekly home visits or phone calls to monitor progress of the patient. Identify population with high propensity to get readmitted
Questions? References :-  Reducing hospital readmissions. By Jenny Minott  Catlin, A. et al. “National Health Spending in 2006: A Year of Change for Prescription Drugs,” Health Affairs, January/February 2008, Vol. 27, No. 1, pp. 14- 29.  Medicare Payment Advisory Commission. 2007. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission, p. 103.  Can readmission rates be used as an outcome indicator? Ruairidh Milne, Aileen Clarke  Benbassat, J. and M. Taragin. “Hospital Readmissions as a Measure of Quality of Health Care,” Archives of Internal Medicine, Vol. 160, No. 8, 2000, pp. 1074-81.  Hospital readmission rates for cohorts of medicare beneficiaries in Boston and New Haven by: E. S. Fisher, J. E. Wennberg, T. A. Stukel, S. M. Sharp