The readmission rate as an indicator of the quality of elective surgical inpatient care for the elderly in New Zealand.
OBJECTIVE
To conduct a hypothesis-raising and descriptive study of the rate of readmission/death for patients aged over 64 years as a measure of the quality of inpatient care, for elective surgical procedures between 2001 and 2004.


METHODS
Data from the New Zealand Health Information Service was used to calculate an annual rate for patients aged 65 years or over between July 2000 and July 2004 who were readmitted or deceased within 30-days of discharge following an: elective transurethral prostatectomy, laparoscopic cholecystectomy, knee arthroplasty, hip arthroplasty, or inguinal hernia repair.


RESULTS
It is probable that the risk of readmission/death within 30-days of discharge ('RoD') rose 13% (95% CI of increase: 0%, 27%) from 7.5% in 2001/2002 to 8.5% in 2003/2004. The risk of RoD was greater among patients aged 80 years or over (RR 1.38, 95% CI 1.26, 1.51), males (RR 1.26, 95% CI 1.12, 1.41), and NZ Maori (RR 1.6, 95% CI 1.2, 2.3).


CONCLUSIONS
There is evidence for a probable increase in the rate of RoD between 2001 and 2004, and its relative risk varied with gender, age, and ethnicity. However, this study was not able to control for potential confounders (length-of-stay, casemix, or comorbidities) which may affect the estimated result. Ongoing research is recommended to explore the use of RoD rate as an indicator of health services quality and consider whether this rate is increasing, despite health system quality interventions. In addition, further investigation is needed to evaluate the quality of hospital care in New Zealand with respect to ethnicity, age, and gender.
Rumball-Smith
Juliet
J
Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand. Juliet.rumball-smith@otago.ac.nz
Hider
Phil
P
Graham
Patrick
P
D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012306:Risk