Results: Of 1.56 million readmissions in the database representing 3.5 million readmissions nationally, 363,590 (23.3%) occurred at a non-index hospital. The patient factors most strongly associated with readmission to a non-index hospital included bring a rural resident of the same state as the index hospital, undergoing prior treatment for alcohol or substance abuse, having Medicare or Medicaid as a primary payor, having a long hospital length of stay, and discharging to a skilled nursing facility for rehabilitation after the hospitalization. Patient factors most strongly associated with being readmitted to the index hospital included being young, severely ill during the index hospitalization or being treated for COPD, and being discharged with home health care (Table 1).
Conclusions: Nearly 1/4 of 30-day readmissions in the United States are readmissions to a non-index hospital. This novel finding in a nationally-representative sample of payers, hospitals, and discharges is surprising and concerning. Hospitals are increasingly held responsible for outcomes and costs of these readmissions, and preliminary evidence indicates non-index readmissions are associated with longer length of stay and increased mortality. However, there is no national system currently for hospitals to identify non-index readmissions. Our results suggest clinicians and hospitals may need to identify the “network” of readmission patterns in their area, and consider multi-site interventions, particularly in the patient sub-populations we identified who are most likely to have non-index readmissions.
To cite this abstract:Jones, CD; Hosokawa, P; Ginde, AA; Burke, RE . ARE YOUR PATIENTS BEING READMITTED ELSEWHERE? INSIGHTS FROM THE NATIONAL READMISSIONS DATABASE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 250. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/are-your-patients-being-readmitted-elsewhere-insights-from-the-national-readmissions-database/. Accessed September 20, 2019.