Public health programs and initiatives that aim to lower hospital admission rates may also reduce readmissions, despite the fact that the patients in communities that have adopted these programs tend to be sicker when hospitalized, says a Yale-led study.
The research was published in the July issue of Health Affairs.
The federal Centers for Medicare and Medicaid Services has created programs and health improvement strategies to help reduce hospital admissions and readmissions. However, hospital groups and policymakers raised concerns about whether these strategies would primarily lower admissions among healthier individuals, resulting in a sicker hospitalized population with worse outcomes, including higher hospital readmission rates. Hospitals with high readmission rates face federal penalties.
To examine this question, the research team used Medicare data for 2010 and 2013. They focused their analyses on communities with hospitals that are major referral centers. For each of these communities, they calculated changes in hospital admission rates and rates of readmission within 30 days after discharge.
The researchers found that a reduction in hospital admissions was strongly associated with a reduction in 30-day readmissions. That finding held true despite the fact that the patients ultimately hospitalized in the communities with large reductions in hospital admission rates were sicker on arrival.
“We’re showing that communities can do a good job of improving both population health and outcomes after hospitalization. These goals are not in conflict,” said Kumar Dharmarajan, M.D., assistant professor of cardiology and first author. Strategies that improve community health overall — better care integration, case management, social service support — appear to also improve health after hospital discharge, he noted.
While the study results may only pertain to older patient populations, they strongly suggest that efforts to improve community health and reduce hospital admissions can go hand in hand, without negatively impacting readmissions and health outcomes, said the researchers.
“Doing the right thing for the patient in one setting seems to help in the other setting as well,” said Dharmarajan.
Other study authors include Li Qin, Zhenqiu Lin, Leora I. Horwitz, Joseph S. Ross, Elizabeth E. Drye, Amena Keshawarz, Faseeha Altaf, Sharon-Lise T. Normand, Harlan M. Krumholz, and Susannah M. Bernheim.
The research was supported by the Centers for Medicare and Medicaid Services, which played no role in designing or conducting the study.
