November 29th, 2011
Study Finds 10% of PCI Patients Readmitted to Hospital Within 30 Days
Nearly 1 in 10 PCI patients is readmitted to the hospital within 30 days, according to a new study published in the Archives of Internal Medicine. The study is a good example of the increased focus on rehospitalization, which is being used more frequently as a key measure of outcome.
Farhan Khawaja and colleagues analyzed data from 15,498 PCI hospitalizations at Saint Marys Hospital in Rochester, MN. Within 30 days after discharge, 9.4% of patients had been readmitted and 0.68% had died. The key independent factors associated with readmission were female sex, Medicare insurance, having less than a high school education, unstable angina, cerebrovascular accident or TIA, moderate to severe renal disease, COPD, peptic ulcer disease, metastatic cancer, and a length of stay of more than 3 days. The authors write that “even though these variables are not modifiable, interventions to improve access and follow-up care should be studied to assess impact on readmission rates.”
In an invited commentary, Adrian Hernandez and Christopher Granger write that “readmission rates may not be closely linked to overall quality.” The increase in 1-year mortality observed in readmitted patients “may simply mean that patients who are readmitted are sicker and more likely to die.” They question whether readmission should be the focus of attention: “Efforts might be most successful in improving quality if the goal is not to prevent readmission but rather to prevent clinical events and decompensation that lead to readmission.”
Nevertheless, they write, readmission as a new standard is “here to stay.” They add: “To reduce readmissions, we need better evidence on effective approaches that address our health systems shortcomings, ideally identifying and intervening in the most vulnerable patients.”