title: Medical and surgical readmissions in the Veterans Health Administration: what proportion are related to the index hospitalization?
abstract: BACKGROUND
  Readmissions are an attractive quality measure because they offer a broad view of quality beyond the index hospitalization. However, the extent to which medical or surgical readmissions reflect quality of care is largely unknown, because of the complexity of factors related to readmission. Identifying those readmissions that are clinically related to the index hospitalization is an important first step in closing this knowledge gap.
  
  
  OBJECTIVE
  The aims of this study were to examine unplanned readmissions in the Veterans Health Administration, identify clinically related versus unrelated unplanned readmissions, and compare the leading reasons for unplanned readmission between medical and surgical discharges.
  
  
  METHODS
  We classified 2,069,804 Veterans Health Administration hospital discharges (Fiscal Years 2003-2007) into medical/surgical index discharges with/without readmissions per their diagnosis-related groups. Our outcome variable was "all-cause" 30-day unplanned readmission. We compared medical and surgical unplanned readmissions (n=217,767) on demographics, clinical characteristics, and readmission reasons using descriptive statistics.
  
  
  RESULTS
  Among all unplanned readmissions, 41.5% were identified as clinically related. Not surprisingly, heart failure (10.2%) and chronic obstructive pulmonary disease (6.5%) were the top 2 reasons for clinically related readmissions among medical discharges; postoperative complications (ie, complications of surgical procedures and medical care or complications of devices) accounted for 70.5% of clinically related readmissions among surgical discharges.
  
  
  CONCLUSIONS
  Although almost 42% of unplanned readmissions were identified as clinically related, the majority of unplanned readmissions were unrelated to the index hospitalization. Quality improvement interventions targeted at processes of care associated with the index hospitalization are likely to be most effective in reducing clinically related readmissions. It is less clear how to reduce nonclinically related readmissions; these may involve broader factors than inpatient care.
authors.affiliation: *Center for Healthcare Organization and Implementation Research (CHOIR) †Department of Surgery, Boston University School of Medicine ‡Department of Operations and Technology Management, Boston University School of Management §Department of Surgery, Brigham and Women's Hospital, Boston ∥Center for Healthcare Organization and Implementation Research (CHOIR), Bedford ¶Section of General Internal Medicine, Boston University School of Medicine #Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Marlena H
authors.initials: MH
authors.lastname: Shin
authors.forename: William
authors.initials: W
authors.lastname: O'Brien
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: Hillary J
authors.initials: HJ
authors.lastname: Mull
authors.forename: Marisa
authors.initials: M
authors.lastname: Cevasco
authors.forename: Ann M
authors.initials: AM
authors.lastname: Borzecki
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*