Report: Seven-Day Readmissions May Be Better Indicator of Quality of Care Than 30 Days Post-Discharge

Most readmissions are determined by community- and household-level factors

Providers have long complained about the use of 30-day readmissions as a measure of between-hospital variations and quality of care, and now a study suggests that a shorter interval (seven days or less) might be a better indicator of the accuracy and equity of readmissions as a measure of hospital quality.

The new findings were published in Health Affairs.

Researchers from the University of California at Davis examined the 30-day risk of unplanned inpatient readmissions for six million Medicare patients (65 years of age and older) at 910 hospitals in four states. The study focused on three conditions: acute myocardial infarction, heart failure, and pneumonia. The investigators found that the hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days. Similar patterns were seen across states and diagnoses.

The rapid decay in the quality signal suggested that most readmissions after the seventh day post-discharge were explained by community- and household-level factors beyond hospitals’ control, according to the authors.

“If the goal of current public policy is to encourage hospitals to assume responsibility for post-discharge adherence and primary care follow-up, then penalties assessed for readmissions within 30 days or longer periods might align appropriately,” the authors concluded. “However, if the goal is empowering patients and families to make health care choices informed by true differences in hospital performance, then a readmission interval of seven days or fewer might be more accurate and equitable.”

A commentary on the study, published in Roll Call, suggested three ways to move away from penalizing hospitals for excessive 30-day readmissions:

  • Shorten the 30-day window or design a measure that allows hospitals to catch complications that may occur after discharge.
  • Apply readmission-rate measures to resource use and not to quality of care.
  • Use readmissions as part of a measure of overall avoidable hospital use.

Sources: FierceHealthcare; October 5, 2016; Health Affairs; October 2016; and Roll Call; October 4, 2016.