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Quality of Care

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Hospital readmissions do not necessarily reflect poor quality of care

When a patient is readmitted to the hospital, it's not necessarily poor quality of care during the first visit that prompts the return, suggests a study supported by the Agency for Health Care Policy and Research (HS06331). It found that some patients hospitalized with congestive heart failure (CHF) or pneumonia experienced poor quality of hospital care. But the relation of quality to the likelihood of readmission was not particularly strong, after accounting for differences in severity of illness. Neither related adverse readmissions (RARs) nor other readmissions appear to be useful tools for identifying patients who experience inferior care or for comparing quality among hospitals, notes Joel S. Weissman, Ph.D., of Massachusetts General Hospital and the Institute for Health Policy.

Dr. Weissman and his colleagues conducted a case control study of 1,758 Medicare patients hospitalized in four States—New York, Pennsylvania, Massachusetts, and Illinois—during 1991 or 1992 with pneumonia or CHF. They used hospital records on readmission diagnoses and intervening time periods to identify readmissions that indicated potentially less than optimal care during initial hospitalization (i.e., RARs). Quality of care was measured using a modification of a tool originally developed by the RAND Corporation to evaluate the effects of the Prospective Payment System.

Low quality of care for CHF occurred among patients with RARs only slightly more frequently than among other patients (17.1 percent, 16.6 percent, and 14.5 percent for RARs, other readmissions, and nonreadmissions, respectively). The percentages for pneumonia (14.9 percent, 12.8 percent, and 13.7 percent) were similar. Also, in simulations, RARs did not discriminate well between average and low quality hospitals. Hospitals with average RAR rates had higher mean quality than hospitals with high RAR rates only 54 percent of the time.

See "Hospital readmissions and quality of care," by Dr. Weissman, John Z. Ayanian, M.D., M.P.P., Scott Chasan-Taber, Ph.D., and others, in the May 1999 Medical Care 37(5), pp. 490-501.

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