Dartmouth Atlas researchers are again pointing fingers at hospital quality of care, this time showing wide variation in 30-day readmission rates, which have not gone down and in some cases rose between 2005 and 2009.
Hospitals see "their responsibility as ending when the patient leaves their door and have made minimal efforts in terms of coordinating care or communicating to community physicians," said David Goodman, MD, lead author and co-principal investigator for the Dartmouth Atlas Project's latest report.
"The result is that readmission to a hospital is a fairly common phenomenon," occurring in between one in six and one in five patients discharged, he said. "Probably the most important finding is that for a long-standing and well-recognized problem, not much progress has been made," Goodman said.
Some hospitals argue that they can't be blamed for high readmission rates because they have sicker patients with more co-morbidities, people who are less well educated and hampered by transportation and poverty. That "may be an explanation, but it shouldn't be an excuse," Goodman said.
While "every hospital and market has its own legitimate story in terms of why they are and where they are today – sometimes it truly is because patients are sicker or poorer – often it's because of an accidental evolution" of the way care is delivered, without coordination or community provider partnerships. Transition processes are "deeply flawed," he said.
The report, entitled "After Hospitalization: A Dartmouth Atlas Report on Post-acute Care for Medicare Beneficiaries," compares readmission rates between 2004 and 2009 for six categories of patients: those admitted for medical care, surgery, congestive heart failure, heart attack, pneumonia, and hip fracture.
It further dissects the data to show rates for each of 1,924 hospitals in the country for those two years. One can see 30-day readmission trends for medium-sized and large cities, hospital referral regions, and states.
The report also reveals that fewer than half of discharged patients followed up with visits to clinicians – an aspect of care said to help prevent readmissions – within 14 days of leaving the hospital. That rate "fell short of any reasonable expectation," said Goodman, Goodman, who also directs the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.
The maps and statistical tables within the document show the percentage of patients for both 2004 and 2009 who were seen by a primary care clinician or went to an ambulatory care center within 14 days of discharge or went to the emergency room within 30 days of discharge.