1. Literature Review: Readmissions and how geographical location of the hospitals affects the rate of readmissions -Shubhshankar

2. What are Readmissions?

3. CMS defines readmission as an admission to a hospital 30 days within the previous discharge. Patient transferred to another hospital are not counted under readmission [1].

4. Why is it a problem?

5. Is readmission rate indicator of quality of Health Care?

7. Reasons for Readmission:- Higher Propensity to get readmitted

8. Reasons for Readmission.

10. Detailed review: Geographical location of hospitals[6]. Boston :4.5 beds per thousand people. New Haven : 2.9 beds per thousand.

11. 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.

12. Results Readmission rates in Boston were 1.64 times the readmission rates in New Haven.

13. 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

14. Explanations? Severity of illness? Nursing home care vs inpatient care?

15. 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.

16. Solutions Weekly home visits or phone calls to monitor progress of the patient. Identify population with high propensity to get readmitted

17. Solutions

18. Follow up appointment with the patient’s physician. Complete discharge summaries within 24 hours

19. Solutions

20. Questions? References :- [1] Reducing hospital readmissions. By Jenny Minott [2] 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. [3] Medicare Payment Advisory Commission. 2007. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission, p. 103. [4] Can readmission rates be used as an outcome indicator? Ruairidh Milne, Aileen Clarke [5] 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. [6] 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