AHRQ-Funded Study Finds Lower Readmission Rates in Low-Volume Hospitals
A typical marker of high-quality hospital care is higher volume, especially for surgical care. However, an AHRQ-funded study has found that 30-day readmission rates are lowest among low-volume hospitals, suggesting that readmissions are associated with aspects of care other than mortality or complications. Using Medicare inpatient data of nearly 7 million adult discharges over a one-year period (2011-2012), researchers found the average risk-standardized 30-day readmission rate for hospitals in the group with the lowest volume was 14.7 percent, compared with 15.9 percent for hospitals in the group with the highest volume. The same pattern of significantly lower standardized readmission rates among the lowest volume hospitals was observed following medicine, cardio-respiratory and neurology admissions, but not following cardiovascular and surgery admissions. The study, titled “Association of Hospital Volume With Readmission Rates: a Retrospective Cross-Sectional Study,” and
abstract were published online February 9 in the journal
BMJ.
BMJ. 2015 Feb 9;350:h447. doi: 10.1136/bmj.h447.
Association of hospital volume with readmission rates: a retrospective cross-sectional study.
Abstract
OBJECTIVE:
To examine the association of hospital volume (a marker of quality of care) with hospital readmission rates. DESIGN:
Retrospective cross-sectional study. SETTING:
4651 US acute care hospitals. STUDY DATA:
6,916,644 adult discharges, excluding patients receiving psychiatric or medical cancer treatment. MAIN OUTCOME MEASURES:
We used Medicare fee-for-service data from 1 July 2011 to 30 June 2012 to calculate observed-to-expected, unplanned, 30 day, standardized readmission rates for hospitals and for specialty cohorts medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology. We assessed the association of hospital volume by quintiles with 30 day, standardized readmission rates, with and without adjustment for hospital characteristics (safety net status, teaching status, geographic region, urban/rural status, nurse to bed ratio, ownership, and cardiac procedure capability. We also examined associations with the composite outcome of 30 day, standardized readmission or mortality rates. RESULTS:
Mean 30 day, standardized readmission rate among the fifth of hospitals with the lowest volume was 14.7 (standard deviation 5.3) compared with 15.9 (1.7) among the fifth of hospitals with the highest volume (P<0.001). We observed the same pattern of lower readmission rates in the lowest versus highest volume hospitals in the specialty cohorts for medicine (16.6 v 17.4, P<0.001), cardiorespiratory (18.5 v 20.5, P<0.001), and neurology (13.2 v 14.0, p=0.01) cohorts; the cardiovascular cohort, however, had an inverse association (14.6 v 13.7, P<0.001). These associations remained after adjustment for hospital characteristics except in the cardiovascular cohort, which became non-significant, and the surgery/gynecology cohort, in which the lowest volume fifth of hospitals had significantly higher standardized readmission rates than the highest volume fifth (difference 0.63 percentage points (95% confidence interval 0.10 to 1.17), P=0.02). Mean 30 day, standardized mortality or readmission rate was not significantly different between highest and lowest volume fifths (20.4 v 20.2, P=0.19) and was highest in the middle fifth of hospitals (range 20.6-20.8). CONCLUSIONS:
Standardized readmission rates are lowest in the lowest volume hospitals-opposite from the typical association of greater hospital volume with better outcomes. This association was independent of hospital characteristics and was only partially attenuated by examining mortality and readmission together. Our findings suggest that readmissions are associated with different aspects of care than mortality or complications. © Horwitz et al 2015.
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