Friday, October 28, 2011

Veterans Health Care: Tools to Predict Hospital Readmissions Perform Poorly

Imprecise risk assessment is limiting the ability of acute care hospitals to identify patients at risk for repeat stays and respond to new federal regulations that will base reimbursement on their ability to minimize readmissions.

Internist Devan Kansagara, MD, and colleagues from the Veterans Affairs Medical Center, Portland, Orgeon, have issued a harsh critique of administrative tools designed for this role. Their evaluation of published studies on the subject identified few risk-prediction models for hospital readmission that have been deemed suitable for clinical or administrative use.

Medicare and Medicaid recently began to publicly disclose hospital readmission rates as a measure of quality hospital care. The Center for Medicare and Medicaid Services intends to lower reimbursement rates for hospitals with high readmission rates.

The authors conclude that more research is needed to better understand the causes and possible ways to prevent readmissions. Models that draw information from medical records or patient reports show potential, although the relative effects of various types of patient data and psychosocial factors on readmission have yet to be well understood.
"Although in certain settings such models may prove useful, better approaches are needed to assess hospital performance in discharging patients, as well as to identify patients at great risk of avoidable readmission," the authors write.
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