Better coordination between hospitals and post-acute care facilities could reduce patient readmission to hospitals and mortality rates, according to a new study of risk factors by researchers from the University of Colorado School of Medicine.
In a review of more than 3,200 hospitalizations followed by stays in post-acute care facilities, the researchers found specific risk factors that may contribute to the need for readmission to the hospital. Nearly half of the readmissions occurred within 14 days of being released from the hospital.
The study, published online in JAMDA, the Journal of Post-Acute and Long Term Care Medicine, identified the patient’s need for an invasive device, such as a feeding tube or urinary catheter, and the patient’s need for advanced care, such as dialysis and oxygen therapy, as factors more common in readmitted patents.
The causes of hospital readmission from post-acute care facilities, which are also called skilled nursing facilities, are critical areas to study in order to improve the quality of patient care and to prepare for reimbursement models that penalize hospitals if patients are readmitted.
“Patients who experienced readmission during their stay in a post-acute care facility were less likely to return to the community,” said lead author Robert Burke, MD, academic hospitalist and health services researcher at the Denver VA Medical Center and an assistant professor at the CU School of Medicine.
Readmitted patients had a higher mortality rate too.
“Readmitted patients were twice as likely as non-readmitted patients to die in the 30 days following hospital discharge and nearly four times as likely to die in the 100 days post-hospital discharge,” the authors write.
The authors also found that payment systems matter and affect patient outcomes.
“Under a prospective payment system, hospitals are incentivized to discharge these patients as early as possible, and in contrast to discharges home, hospitals are not currently penalized for readmissions from PAC (post-acute care) facilities,” the authors write. “PAC facilities may be substituting for prolonged hospital care in some cases.”
Hospitals and post-acute care facilities need to focus on patient selection and on processes for transitioning care from the hospital to the post-acute care facility.
Burke’s fellow authors on the article are Emily Whitfield, PhD, of the Denver-Seattle Center of Innovation at the Denver VA Medical Center; and David Hittle, PhD, Sung-Joon Min, PhD, Cari Levy, MD, PhD, Allan V. Prochazka, MD, MSc, Eric A. Coleman, MD, MPH, Robert Schwartz, MD, and Adit A. Ginde, MD, MPH, all of whom are faculty members of the University of Colorado School of Medicine.
The research was funded by the Hartford Foundation/Jahnigen Center of Excellence at the University of Colorado.