Elsevier

Social Science & Medicine

Volume 43, Issue 11, December 1996, Pages 1533-1541
Social Science & Medicine

A conceptual framework for the study of early readmission as an indicator of quality of care

https://doi.org/10.1016/S0277-9536(96)00049-4Get rights and content

Abstract

Despite the perennial popularity of readmission as an indicator of the quality of hospital care, the empiric evidence linking it to process-of-care problems during the prior hospitalization is inconsistent. We devised a conceptual model for the use of unscheduled readmission within 31 days as an indicator of the quality of medical-surgical inpatient care for adults, and then conducted a systematic review of the readmission literature to determine the extent to which the evidence supports the proposed relationships. A fairly complex web of relationships influences the association between the process of inpatient care and early readmission. From the evidence to date, it is impossible to say with confidence that early readmission is or is not a valid and useful quality indicator. In most negative studies, the absence of an association appears to be explainable on the basis of improper study design, omission of important variables, or mis-specification of variables. Variables intervening between or confounding the relationship of the process of inpatient care to early readmission have received inadequate attention in past work. Investigators can use the proposed model and literature review to ensure their work advances the field and puts the hypothesis that early readmission is a valid quality indicator to a rigorous test. This matter has a certain urgency in view of the vast amount of resources that providers and payers devote to monitoring readmission rates and reviewing readmissions.

Reference (39)

  • GrahamH. et al.

    Can readmissions to a geriatric medical unit be prevented?

    Lancet

    (1983)
  • ThomasJ.W. et al.

    Investigating early readmission as an indicator for quality of care studies

    Med. Care

    (1991)
  • An analysis of readmissions using Pittsburgh Business Group on Health hospital claims data

    (1989)
  • ClarkeA.

    Are readmissions avoidable?

    Br. Med. J.

    (1990)
  • AshtonC.M. et al.

    Predicting readmission in veterans with chronic disease

    Development and validation of discharge criteria

    Med. Care

    (1987)
  • TopolE.J. et al.

    A randomized trial of hospital discharge three days after myocardial infarction in the era of reperfusion

    N. Engl. J. Med.

    (1988)
  • WilliamsE.I. et al.

    Factors affecting early unplanned readmission of elderly patients to hospital

    Br. Med. J.

    (1988)
  • ManheimL.M. et al.

    Training house officers to be cost conscious

    Effects of an intervention on length of stay and hospital charges

    Med. Care

    (1990)
  • FeinglassJ. et al.

    The effect of physician practice style on hospital resource use

    Hlth Serv. Res.

    (1991)
  • ReedR.L. et al.

    Risk factors for early unplanned readmission in the elderly

    J. Gen. Intern. Med.

    (1991)
  • SimmerT.L. et al.

    A randomized, controlled trial of an attending staff service in general internal medicine

    Med. Care

    (1991)
  • HaywardR.A. et al.

    An evaluation of generic screens for poor quality of hospital care on a general medicine service

    Med. Care

    (1993)
  • LudkeR.L. et al.

    Relationship between early readmission and hospital quality of care indicators

    Inquiry

    (1993)
  • AshtonC.M. et al.

    The association between residents' work rounds styles and the process and outcome of medical care

    J. Gen. Intern. Med.

    (1994)
  • AshtonC.M. et al.

    The association between the process of inpatient care and early readmission

    Ann. Intern. Med.

    (1995)
  • Ashton C. M., del Junco D. J., Mansyur C., Wray N. P. and Souchek J. The association between the quality of inpatient...
  • LudkeR.L. et al.

    Appropriateness of admissions and discharges among readmitted patients

    Hlth Serv. Res.

    (1990)
  • HollowayJ.J. et al.

    Factors influencing readmission risk: implications for quality monitoring

    Hlth Care Finan. Rev.

    (1989)
  • DesHarnaisS. et al.

    Measuring outcomes of hospital care using multiple risk-adjusted indexes

    Hlth Serv. Res.

    (1991)
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