NLM Director’s Comments Transcript
Hospital Readmissions Reconsidered: 03/18/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

Most patients with heart failure, a heart attack, and pneumonia are not readmitted to a hospital within a month for the same condition, suggests a national study recently published in the Journal of the American Medical Association. An insightful editorial that accompanies the research adds the study’s findings reinforce a need to improve medical care coordination, which eventually might reduce readmission rates and bypass new hospital fines for excessive readmissions.
First, the study’s analysis of about 975,000 cases (nationally-derived from Medicare data between 2007-2009) found nearly 25 percent of patients with heart failure, about 20 percent who had a heart attack, and about 18 percent with pneumonia were readmitted to a hospital within 30 days. However within each group, the proportion of Medicare patients readmitted for a new development from the same condition was only 35 percent for heart failure, 10 percent for a heart attack, and about 22 percent for pneumonia. The average patient readmission occurred within 10-12 days.
In short, the study found most heart failure, heart attack, and pneumonia patients are re-hospitalized for medical reasons other than their initial diagnosis.
The authors explain heart failure, heart attack, and pneumonia are perceived as illnesses with a high likelihood of hospital readmission where returns often are foreseen to be a new development of the same condition. The latter expectation impacts how hospitals anticipate and organize patient care needs.
Alternatively, the study’s findings suggest there is (and we quote) a ‘diverse spectrum of readmission diagnoses’ (end of quote) that occurs consistently regardless of age, gender, or race in the nation’s hospitals.
An accompanying editorial adds since last fall hospitals have been fined by the U.S. Centers for Medicare and Medicaid Services (CMS) for excessive readmissions. The editorial adds about 2000 U.S. hospitals are expected to be fined about $300 million for excessive readmissions in 2013 and these penalties may increase significantly in 2014.
The editorial’s author, Mark Williams M.D., Northwestern University Feinberg School of Medicine, writes (and we quote): ‘penalties for readmissions of patients discharged after hospitalizations for heart failure, acute myocardial infarction, or pneumonia are driving change across the United States’ [among hospitals and medical centers] (end of quote).
Williams notes an inference from the study’s findings is hospitals might curb fines and curtail readmissions if they focus on an array of illnesses associated with heart failure, heart attacks, and pneumonia instead of targeting efforts on the admitting diagnosis.
Williams explains the current — in addition to two other studies published in the same JAMA issue — suggest a pressing need to improve the experience and sharing of information as patients (and we quote) ‘transition from emergency departments, skilled nursing facilities, and home during episodes of acute illness with a background of chronic disease’ (end of quote).
Williams adds the latter shift in emphasis requires increased patient-centered efforts as well as enhanced care coordination across diverse clinical specialties within hospitals and medical centers.
Williams notes enhanced care coordination efforts should include (and we quote) ‘proven quality improvement methods such as a statistical control process to identify helpful interventions’ (end of quote).
Meanwhile, MedlinePlus.gov’s health facilities health topic page provides an overview to help you choose a hospital (from the Joint Commission) in the ‘start here’ section. A guide to selecting quality health care (provided by the Agency for Healthcare Research and Quality) is available within the ‘overviews’ section of MedlinePlus.gov’s health facilities health topic page.
CMS additionally provides a useful hospital discharge-planning checklist in the ‘related issues’ section of MedlinePlus.gov’s health facilities health topic page.
MedlinePlus.gov’s health facilities health topic page also contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the health facilities health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s health facilities health topic page, just type ‘health facilities’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘health facilities (National Library of Medicine).’ MedlinePlus also contains several other related health topic pages, including health system.
We should add the current JAMA studies and editorial add to a recent, growing body of knowledge about the status of post-hospital care and its implications for patients, medical costs, and health care regulatory policy. As Dr. Williams suggests in his editorial, the aggregate findings provide a range of insights that could enhance hospital care and patient experiences.
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