Factors such as having a usual source of care, private insurance, and available primary care physicians tend to reduce the likelihood of preventable hospital admissions for conditions such as asthma and diabetes complications. However, preventable hospital readmissions may be more strongly determined by the severity and complexity of the patient's underlying chronic problems, according to a recent study. These readmissions may also indicate persistent problems in the hospital and in followup by families and physicians after discharge, explain Bernard Friedman, Ph.D., and Jayasree Basu, Ph.D., of the Agency for Healthcare Research and Quality.
To prevent these rehospitalizations, Drs. Friedman and Basu suggest identifying patients at risk for readmission before hospital discharge, followup strategies after discharge, and sufficient payment for management of chronic diseases with office-based services and drugs. The researchers analyzed 1999 hospital discharge data for residents of New York, Pennsylvania, Tennessee, and Wisconsin from the Healthcare Cost and Utilization Project (HCUP). They estimated the rate and cost of preventable readmissions within 6 months after a first preventable admission by age group and by payer and race within each age group.
About 19 percent of individuals with an initial preventable admission had at least one preventable readmission within 6 months. Hospital costs for preventable readmissions during 6 months was about $730 million (about $7,400 per readmission). For children and nonelderly adults, the proportion with a
readmission was much lower for privately insured patients than for either Medicaid or self-pay patients. The likelihood of readmission was higher for blacks and Hispanics than for whites and members of other racial groups. Medicaid was not associated with a lower rate of readmission. Uninsured children had a higher rate of readmission but not uninsured adults.
See "The rate and cost of hospital readmissions for preventable conditions," by Drs. Friedman and Basu, in the June 2004 Medical Care Research and Review 61(2), pp. 225-240.
Reprints (AHRQ Publication No. 04-R056) are available from the AHRQ Publications Clearinghouse.
Editor's Note: Another study by these authors on a related topic found that in different States, private health maintenance organization (HMO) enrollment was associated with fewer preventable hospital admissions than urgent admissions (insensitive to primary care) compared with private fee-for-service (FFS) plan enrollment. However, little difference was found between Medicaid HMO enrollees and Medicaid fee-for-service patients. The findings did not vary by the level of Medicaid managed care penetration in the study States. For more details, see Basu, J., Friedman, B., and Burstin, H. (2004, June). "Managed care and preventable hospitalization among Medicaid adults." Health Services Research 39(3), pp. 489-509.
Reprints (AHRQ Publication No. 04-R053) are available from the AHRQ Publications Clearinghouse.
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