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National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016
  1. Rocco Friebel1,2,
  2. Katharina Hauck1,
  3. Paul Aylin1,
  4. Adam Steventon2
  1. 1 School of Public Health, Imperial College London, London, UK
  2. 2 Data Analytics, The Health Foundation, London, UK
  1. Correspondence to Rocco Friebel; rocco.friebel{at}health.org.uk

Abstract

Objective To assess trends in 30-day emergency readmission rates across England over one decade.

Design Retrospective study design.

Setting 150 non-specialist hospital trusts in England.

Participants 23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016.

Primary and secondary outcomes We examined emergency admissions that occurred within 30 days of discharge from hospital (‘emergency readmissions’) as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay.

Results The average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (−1.29%; P<0.001); for acute myocardial infarction (−0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased.

Conclusions Overall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.

  • quality of care
  • readmission rates
  • variation in quality of care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors RF had the idea for this study. RF and AS came up with the statistical analysis plan. RF carried out the analysis. RF, AS, KH and PA drafted and finalised the paper.

  • Funding This research was conducted independently, but has received support by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in modelling methodology at Imperial College London in partnership with Public Health England (PHE), and by the MRC centre for outbreak analysis and modelling (funding reference: MR/K010174/1B).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data controller of the data analysed is NHS Digital. Patient-level data are available subject to their information governance requirements.

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