Four Myths about Hospital Readmission
We describe these myths in the hope that greater awareness and understanding of these dynamics will help health care providers make the best use of scarce resources as they support patients after discharge.
Myth 1. Hospitals that schedule a follow-up appointment before the inpatient stay is over have reliably lower readmission rates.
Appointments scheduled in this way often result in no-shows—anecdotally, as often as 60-75% of the time, depending on the hospital population. This hinders readmission reduction efforts.
Myth 2. Diagnosis is key.
We studied nineteen supposedly high-risk diagnoses (e.g., heart failure, COPD, metastatic cancer) that together include about half of all inpatients. Statistical analysis involving 172,000 discharges from hospitals from Louisiana to Massachusetts shows that presence or absence of these nineteen diagnoses together accounts for only 2-5% of the variation in (“the story of”) readmission status.
Myth 3. Having a mental health comorbidity substantially raises one’s risk.
We’ve tested dozens of statistical models that have used presence/absence of a mental health diagnosis to try and predict readmission status. Not in a single instance have patients with mental health comorbidities shown significantly higher readmission rates than seen in the wider inpatient population. It makes little difference whether the mental health variable is examined as a single predictor or while controlling for others. On the other hand, some researchers have found the specific diagnosis of depression to be an important risk factor. 1,
Myth 4. Age is an important risk factor.
Age may be the most overestimated risk factor for readmission. It is true that, on the surface, older patients are more likely to readmit. But that is without controlling for other key variables, principally those indicating how severe one’s illness is. Once such statistical controls are put in place, the connection between readmission and age usually evaporates. Two patients who are equally sick, one much older than the other, will have equal risks of readmitting.