title: Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care.
abstract: Public reporting and payment programs in the United States have embraced thirty-day readmissions as an indicator of between-hospital variation in the quality of care, despite limited evidence supporting this interval. We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals' control. Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.
authors.affiliation: David L. Chin (dlchin@ucdavis.edu) is a postdoctoral scholar at the Center for Healthcare Policy and Research, University of California, Davis, in Sacramento.
authors.forename: David L
authors.initials: DL
authors.lastname: Chin
authors.affiliation: Heejung Bang is a professor of biostatistics in the Department of Public Health Sciences, University of California, Davis.
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
authors.affiliation: Raj N. Manickam is a graduate student researcher in the Graduate Group in Epidemiology, University of California, Davis.
authors.forename: Raj N
authors.initials: RN
authors.lastname: Manickam
authors.affiliation: Patrick S. Romano is a professor of medicine and pediatrics in the Division of General Medicine at the University of California, Davis, School of Medicine and at the Center for Healthcare Policy and Research.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D000368:Aged; D001130:Arizona; D002140:California; D005260:Female; D005431:Florida; D005102:Health Expenditures; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D009518:New York; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D011787:Quality of Health Care / Q000592:standards*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Hospital Quality Signal; Hospital Readmissions Reduction Program; National Healthcare Policy; Quality Measurement; Readmission Interval