One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to a Commonwealth Fund-supported study in a recent New England Journal of Medicine.
Those statistics added up to a whopping $17.4 billion for Medicare in 2004, the study says. The study, "Rehospitalizations Among Patients in the Medicare Fee-for-Service Program," by Stephen Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H., highlights the costs and health impact of rehospitalization. It also details the key reasons for rehospitalizations, and highlights gaps in patient management that may be contributing to the high rates.
Surprisingly, most patients were rehospitalized for conditions other than those for which they were originally hospitalized.
Hospitalizations were so rapid that these conditions should probably have been the focus of discharge planning in many cases. Overall, 73 percent of patients who were initially in the hospital for surgery were readmitted for medical diagnoses such as pneumonia, heart failure or bacterial infections.
The study also showed that a history of rehospitalization and prolonged length of hospital stay were stronger predictors of rehospitalization than age, gender, race, poverty or disability. The authors suggest several steps to reduce rehospitalizations including:
• Interventions to better educate patients about self-care in the hospital discharge process;
• Helping hospitals better understand their comparative performance on readmissions by providing them readmission data for their patients including those who were rehospitalized elsewhere;
• Collaboration between physicians and hospitals to ensure patients get follow-up care; and
• Follow-up care from a primary care doctor as well as a surgeon for surgery patients.
At-home non-medical assistance also could be of benefit. Home Instead CAREGivers often handle tasks around the house such as meal preparation, light housekeeping and medication reminders, which can help seniors devote their energy to recovering.
