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Regional Rehospitalization Rate Tied to Overall Admissions

Overall admission rates explain more of variance in rehospitalization rates than other factors

WEDNESDAY, Dec. 14 (HealthDay News) -- For patients with congestive heart failure or pneumonia, regional rates of rehospitalizations are substantially associated with overall admission rates at 30, 60, and 90 days, according to a study published in the Dec. 15 issue of the New England Journal of Medicine.

Arnold M. Epstein, M.D., from Harvard School of Public Health in Boston, and colleagues investigated variations in hospital referral region (HRR) readmission rates among patients initially hospitalized for congestive heart failure or pneumonia. All-cause readmission rates for Medicare enrollees were estimated in each HRR. The role of various factors in the variation in HRR readmissions was investigated.

The investigators found that HRR readmission rates varied from 11 to 32 percent and 8 to 27 percent for congestive heart failure and pneumonia, respectively. Univariate analyses for congestive heart failure revealed that the highest proportions of regional variation in readmission rates were explained by all-cause admission at 30, 60, and 90 days (28, 34, and 37 percent, respectively), followed by case mix (11, 15, and 18 percent, respectively), and the number of cardiologists per capita (12, 14, and 15 percent, respectively). Similar results were observed for pneumonia, except for a lower proportion of the variation explained by the number of pulmonologists per capita (6, 8, and 7 percent, respectively). Based on multivariate analyses, 16 to 24 percent of the variation in congestive heart failure readmission rates and 11 to 20 percent of the variance in pneumonia readmission rates were explained by admission rates; no other factor accounted for more than 6 percent.

"We found a substantial association between regional rates of rehospitalization and overall admission rates," the authors write. "Programs directed at shared savings from lower utilization of hospital services might be more successful in reducing readmissions than programs initiated to date."

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