title: Hospital readmissions: necessary evil or preventable target for quality improvement.
abstract: OBJECTIVE
  To evaluate readmission rates and associated factors to identify potentially preventable readmissions.
  
  
  BACKGROUND
  The decision to penalize hospitals for readmissions is compelling health care systems to develop processes to minimize readmissions. Research to identify preventable readmissions is critical to achieve these goals.
  
  
  METHODS
  We performed a retrospective review of University HealthSystem Consortium database for cancer patients hospitalized from January 2010 to September 2013. Outcome measures were 7-, 14-, and 30-day readmission rates and readmission diagnoses. Hospital and disease characteristics were evaluated to evaluate relationships with readmission.
  
  
  RESULTS
  A total of 2,517,886 patients were hospitalized for cancer treatment. Readmission rates at 7, 14, and 30 days were 2.2%, 3.7%, and 5.6%, respectively. Despite concern that premature hospital discharge may be associated with increased readmissions, a shorter initial length of stay predicted lower readmission rates. Furthermore, high-volume centers and designated cancer centers had higher readmission rates. Evaluating institutional data (N = 2517 patients) demonstrated that factors associated with higher readmission rates include discharge from a medical service, site of malignancy, and emergency primary admission. When examining readmission within 7 days for surgical services, the most common readmission diagnoses were infectious causes (46.3%), nausea/vomiting/dehydration (26.8%), and pain (6.1%).
  
  
  CONCLUSIONS
  A minority of patients after hospitalization for cancer-related therapy are readmitted with potentially preventable conditions such as nausea, vomiting, dehydration, and pain. However, most factors associated with readmission cannot be modified. In addition, high-volume centers and designated cancer centers have higher readmission rates, which may indicate that readmission rates may not be an appropriate marker for quality improvement.
authors.affiliation: *Division of Surgical Oncology, UC Davis Cancer Center, Sacramento, CA; and †Division of Biostatistics, Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, CA.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brown
authors.forename: Debra
authors.initials: D
authors.lastname: Burgess
authors.forename: Chin-Shang
authors.initials: CS
authors.lastname: Li
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D003681:Dehydration / Q000175:diagnosis; D017048:Health Care Costs; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000175:diagnosis; D007902:Length of Stay; D009369:Neoplasms / Q000601:surgery; D010149:Postoperative Pain / Q000175:diagnosis; D010359:Patient Readmission / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data*; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis; D058996:Quality Improvement; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D013923:Thromboembolism / Q000175:diagnosis; D014481:United States