title: Examination of unplanned 30-day readmissions to a comprehensive cancer hospital.
abstract: OBJECTIVE
  The Centers for Medicare and Medicaid Services (CMS), under the Hospitals Readmissions Reductions Program, may withhold regular reimbursements for excessive 30-day readmissions for select diagnoses. Such penalties imply that some readmissions reflect poor clinical decision making or care during the initial hospitalization. We examined factors related to potentially preventable readmissions in CMS patients at a tertiary cancer hospital.
  
  
  METHODS
  The medical records of all CMS patients with unplanned readmissions within 30 days of index admission were reviewed over 6 months (October 15, 2011-April 15, 2012). Each readmission was classified as not preventable or potentially preventable. Factors associated with potentially preventable readmissions were sought.
  
  
  RESULTS
  Of 2,531 inpatient admissions in CMS patients over 6 months, 185 patients experienced at least one readmission for 282 total readmissions (11%). Median time to readmission was 9 days (range, 0 to 30 days). The most common causes for first readmission were new diagnoses not present at first admission (n = 43, 23%), new or worsening symptoms due to cancer progression (n = 40, 21%) and complications of procedures (n = 25, 13%). There were 38 (21%) initial readmissions classified as potentially preventable. Use of total parenteral nutrition at the time of discharge was associated with potentially preventable readmission (P = .028).
  
  
  CONCLUSIONS
  Most unplanned readmissions to a tertiary cancer hospital are related to progression of disease, new diagnoses, and procedure complications. Minimizing readmissions in complex cancer patients is challenging. Larger multi-institutional datasets are needed to determine a reasonable standard for expected readmission rates.
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Neil David
authors.initials: ND
authors.lastname: Saunders
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Shawnn D
authors.initials: SD
authors.lastname: Nichols
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Michael Alfredo
authors.initials: MA
authors.lastname: Antiporda
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Kristen
authors.initials: K
authors.lastname: Johnson
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Kerri
authors.initials: K
authors.lastname: Walker
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Nilsson
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Lisa
authors.initials: L
authors.lastname: Graham
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Matt
authors.initials: M
authors.lastname: Old
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Klisovic
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Sam
authors.initials: S
authors.lastname: Penza
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, OH carl.schmidt@osumc.edu.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult