Impact of time from discharge to readmission on outcomes: an observational study from the US National Readmission Database

Abstract

Background: The Hospital Readmission Reduction Programme (HRRP) was created to decrease the number of hospital readmissions for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia (PNA), coronary artery bypass graft (CABG), elective total hip arthroplasty (THA) and total knee arthroplasty.

Objectives: To analyse the impact of the HRRP on readmission rates from 2010 to 2019 and how time to readmission impacted outcomes.

Design: Population-based retrospective study.

Setting: All patients included in the US National Readmission database from 2010 to 2019.

Patients: We recorded demographic and clinical variables.

Measurements: Using linear regression models, we analysed the association between readmission status and timing with death and length of stay (LOS) outcomes. We transformed LOS and charges into log-LOS and log-charges to normalise the data.

Results: There were 31 553 363 records included in the study. Of those, 4 593 228 (14.55%) were readmitted within 30 days. From 2010 to 2019, readmission rates for COPD (20.8%-19.8%), HF (24.9%-21.9%), PNA (16.4%-15.1%), AMI (15.6%-12.9%) and TKR (4.1%-3.4%) decreased whereas CABG (10.2%-10.6%) and THA (4.2%-5.8%) increased. Readmitted patients were at higher risk of mortality (6% vs 2.8%) and had higher LOS (3 (2-5) vs 4 (3-7)). Patients readmitted within 10 days had a mortality 6.4% higher than those readmitted in 11-20 days (5.4%) and 21-30 days (4.6%). Increased time from discharge to readmission was associated with a lower likelihood of mortality, like LOS.

Conclusion: Over the last 10 years, readmission rates decreased for most conditions included in the HRRP except CABG and THA. Patients readmitted shortly after discharge were at higher risk of death.

Keywords: Hospitals; Medicine; Mortality.

Figure 1. Readmission rates from 2010 to 2019 by conditions. AMI, acute myocardial infarction; CABG, coronary artery bypass graft; CHF, chronic heart failure; COPD, chronic obstructive pulmonary disease; PNA, pneumonia; THA, total hip arthroplasty; TKA, total knee arthroplasty.