title: Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions.
abstract: BACKGROUND
  Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions.
  
  
  METHODS
  In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%.
  
  
  RESULTS
  Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%-14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%-19.1%; 2.2% of those discharged, 95% CI 1.8%-2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%-22.5%; χ(2) = 92.9, p < 0.001); the proportion of readmissions deemed avoidable did not show significant variation by hospital (range 1.2%-3.7%; χ(2) = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41).
  
  
  CONCLUSIONS
  Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ont. carlv@ohri.ca
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.forename: Alison
authors.initials: A
authors.lastname: Jennings
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.forename: Irfan
authors.initials: I
authors.lastname: Dhalla
authors.forename: Shane
authors.initials: S
authors.lastname: English
authors.forename: Sunita
authors.initials: S
authors.lastname: Mulpuru
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009864:Ontario; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data